Provider Demographics
NPI:1225620990
Name:ELWELL, JAMIE NICOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:NICOLE
Last Name:ELWELL
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 1:214 TAWNY BARK DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6817
Mailing Address - Country:US
Mailing Address - Phone:814-853-5546
Mailing Address - Fax:
Practice Address - Street 1:13655 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:WEDDINGTON
Practice Address - State:NC
Practice Address - Zip Code:28104-9373
Practice Address - Country:US
Practice Address - Phone:704-246-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist