Provider Demographics
NPI:1174523997
Name:OWEN, LANDON KEITH (PT)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:KEITH
Last Name:OWEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 EATON PL STE 312
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:703-995-4860
Practice Address - Street 1:10400 EATON PL STE 312
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2208
Practice Address - Country:US
Practice Address - Phone:703-391-2450
Practice Address - Fax:703-995-4860
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist