Individual
MR. BRYAN JOE OWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
119 E GIRARD AVE, CEDARTOWN, GA 30125-2711
(770) 855-0977
(404) 795-0690
Mailing address
21 MOUNTAINVIEW CT, CEDARTOWN, GA 30125-4688
(770) 855-0977
(404) 795-0690
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
GA 004890
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10036138
AMERIGROUP
GA
01
—
330841
WELL CARE
GA
Enumeration date
11/10/2006
Last updated
07/09/2007
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