Basic Information
| Provider Information | |||||||||
| NPI: | 1477927416 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OWSLEY | ||||||||
| FirstName: | PHILIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4560 SE INTERNATIONAL WAY | ||||||||
| Address2: | #100 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972224628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712065202 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 S 224TH ST | ||||||||
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| City: | DES MOINES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981985132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068240600 | ||||||||
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| ProviderEnumerationDate: | 11/13/2015 | ||||||||
| LastUpdateDate: | 11/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | P160498378 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.