Provider Demographics
NPI:1043822356
Name:JEWETT, PATRICK T (DPT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:JEWETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 SARASOTA CT
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4562
Mailing Address - Country:US
Mailing Address - Phone:231-343-0170
Mailing Address - Fax:
Practice Address - Street 1:1635 W SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-3544
Practice Address - Country:US
Practice Address - Phone:231-755-4404
Practice Address - Fax:231-755-7704
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist