Individual provider Active NPI

Tyler Owen

  • Physical Therapist
  • Moncks Corner, SC
National Provider Identifier
1780304188
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
116 Foxbank Plantation Blvd Ste E
Moncks Corner, SC 29461-6706
Phone
(843) 761-4622
NPI assigned
Aug 29, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

116 Foxbank Plantation Blvd Ste E
Moncks Corner, SC 29461-6706

Mailing address

1713 Cheryl LN
Summerville, SC 29486-7937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221024001902 SC Practitioner - Physical Therapist in Private Practice 6800262411 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11495SCMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Empowerme Rehabilitation, LLC Physical Therapist CurrentSince Jun 2, 2023 Accepting new patients
RSFH - Ati Physical Therapy, LLC Physical Therapist CurrentSince Oct 3, 2022 Accepting new patients
Greenville Proaxis Therapy LLC CurrentSince Feb 1, 2023 Accepting new patients
Empowerme Rehabilitation, LLC Physical Therapist CurrentSince Jun 2, 2023 Accepting new patients
RSFH - Ati Physical Therapy, LLC Physical Therapist CurrentSince Oct 3, 2022 Accepting new patients
Greenville Proaxis Therapy, LLC Physical Therapist CurrentSince Feb 1, 2023 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33205 Collection Ctr Dr
Chicago, IL 60693

33299 Collection Ctr Dr
Chicago, IL 60693

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 287-3917

2333 Ashley River Rd
Charleston, SC 29414
Phone (843) 258-5538

103 N Main St
Ste 201
Greenville, SC 29601
Phone (864) 528-5753

203 E Butler Rd
#C
Mauldin, SC 29662
Phone (864) 268-6686

116 Foxbank Plantation Blvd
Ste E
Moncks Corner, SC 29461
Phone (843) 761-4622

9241 University Blvd
Ste B1
North Charleston, SC 29406
Phone (843) 414-1140

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1780304188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1713 CHERYL LN",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294867937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 FOXBANK PLANTATION BLVD STE E",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294616706",
            "telephone_number": "843-761-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWEN",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-29",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moncks Corner, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.