Provider Demographics
NPI:1518602390
Name:CHELLEW, JAMIE (PTA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CHELLEW
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 1:1604 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1970
Mailing Address - Country:US
Mailing Address - Phone:816-390-7169
Mailing Address - Fax:
Practice Address - Street 1:1604 ASPEN DR
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1970
Practice Address - Country:US
Practice Address - Phone:816-390-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079912225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant