Provider Demographics
NPI:1588722136
Name:OWENS, JAMES (PT, MS,CERT MDT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:PT, MS,CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2849 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1216
Mailing Address - Country:US
Mailing Address - Phone:616-956-0400
Mailing Address - Fax:616-956-0404
Practice Address - Street 1:2849 MICHIGAN ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1216
Practice Address - Country:US
Practice Address - Phone:616-956-0400
Practice Address - Fax:616-956-0404
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1066001Medicare PIN