Tyler Owen, PTA
Individual provider Active NPI Physical Therapy Assistant · Jasper, FL
NPI 1700460797 · NPPES record last updated May 6, 2021
Key facts
- NPI
- 1700460797
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- PTA30863 (FL)
- Practice address
- 427 15TH Ave NW
Jasper, FL 32052-5874 - Phone
- (386) 792-1868
- NPI assigned
- May 6, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA30863 | FL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA30863 | FL | Yes |
Addresses
Primary practice location
427 15TH Ave NW
Jasper, FL 32052-5874
Mailing address
8477 S Suncoast Blvd
Homosassa, FL 34446-5028
Phone (352) 382-7214
Other providers in Jasper, FL
- W. Benjamin Norris Jr.
- North Florida Pediatrics, PA
- North Florida Pediatrics, PA
- North Florida Pediatrics, PA.
- One Stop Staffing, Training, & Consulting LLC
- Yong Park
- Amanda Parks
- Ke'Amber Paul
- Mona Payne
- Stephanie Rose Pierdinock
All providers in Jasper, FL · Physical Therapy Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.