Provider Demographics
NPI:1174748131
Name:JEWETT, KATIE ELIZABETH (PT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:JEWETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 FLYNN AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5429
Mailing Address - Country:US
Mailing Address - Phone:802-863-9900
Mailing Address - Fax:802-863-9922
Practice Address - Street 1:208 FLYNN AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5429
Practice Address - Country:US
Practice Address - Phone:802-863-9900
Practice Address - Fax:802-863-9922
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT000375701Medicare PIN
VT000375702Medicare PIN