Provider Demographics
NPI:1962701904
Name:OWENS, GERALD STEVEN JR
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:STEVEN
Last Name:OWENS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 PENNEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6145
Mailing Address - Country:US
Mailing Address - Phone:786-400-8576
Mailing Address - Fax:
Practice Address - Street 1:357 PENNEY VIEW CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6145
Practice Address - Country:US
Practice Address - Phone:786-400-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner