Provider Demographics
NPI:1467717884
Name:JEWETT, LAURA VERELLEN (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:VERELLEN
Last Name:JEWETT
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 1:1800 S JACKSON ST APT 307
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2183
Mailing Address - Country:US
Mailing Address - Phone:206-228-4023
Mailing Address - Fax:
Practice Address - Street 1:4700 42ND AVE SW
Practice Address - Street 2:#510
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4591
Practice Address - Country:US
Practice Address - Phone:206-933-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist