Basic Information
Provider Information
NPI: 1538893656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OWENS
FirstName: WILLIAM
MiddleName: ROSS
NamePrefix: DR.
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1120 SE CARY PKWY STE 101
Address2:  
City: CARY
State: NC
PostalCode: 275187413
CountryCode: US
TelephoneNumber: 9194677801
FaxNumber: 9192353399
Practice Location
Address1: 1120 SE CARY PKWY STE 101
Address2:  
City: CARY
State: NC
PostalCode: 275187413
CountryCode: US
TelephoneNumber: 9194677801
FaxNumber: 9192353399
Other Information
ProviderEnumerationDate: 07/14/2022
LastUpdateDate: 07/14/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/14/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XP19331NCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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