Provider Demographics
NPI:1023320132
Name:OWENS, RACHAEL LEE CUMMINS (DPT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LEE CUMMINS
Last Name:OWENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 ZOYSIA LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8448
Mailing Address - Country:US
Mailing Address - Phone:417-268-7722
Mailing Address - Fax:
Practice Address - Street 1:1065 CLAYTON ST STE 9
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4335
Practice Address - Country:US
Practice Address - Phone:501-328-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 32572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR183268721Medicaid
AR5V365Medicare UPIN