Provider Demographics
NPI:1275390874
Name:JARRELLS, MIKAYLA (PTA)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:JARRELLS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 SHOEMAKER RD SW
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43837-9210
Mailing Address - Country:US
Mailing Address - Phone:330-440-9189
Mailing Address - Fax:
Practice Address - Street 1:4830 SHOEMAKER RD SW
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43837-9210
Practice Address - Country:US
Practice Address - Phone:330-440-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013323225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant