Provider Demographics
NPI:1548467061
Name:OWEN, ROSLYN HELENE (RPT)
Entity type:Individual
Prefix:MS
First Name:ROSLYN
Middle Name:HELENE
Last Name:OWEN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:ROSLYN
Other - Middle Name:HELENE
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:620 EDER RD
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582-5200
Mailing Address - Country:US
Mailing Address - Phone:845-221-0214
Mailing Address - Fax:845-221-0214
Practice Address - Street 1:620 EDER RD
Practice Address - Street 2:
Practice Address - City:STORMVILLE
Practice Address - State:NY
Practice Address - Zip Code:12582-5200
Practice Address - Country:US
Practice Address - Phone:845-221-0214
Practice Address - Fax:845-221-0214
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0069501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02202853Medicaid