Basic Information
| Provider Information | |||||||||
| NPI: | 1619560695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | |||||||||
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| Credential: | RBT, CBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2522 N PROCTOR ST STE 27 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984065338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883623970 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 31418 62ND AVENUE CT S | ||||||||
| Address2: | |||||||||
| City: | ROY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985808712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883623970 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2021 | ||||||||
| LastUpdateDate: | 02/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
ID Information
| ID | Type | State | Issuer | Description | CB61137437 | 01 | WA | CBT | OTHER | RBT-21-155310 | 01 | RBT | OTHER |