Provider Demographics
NPI:1578761144
Name:JEWELL, ASHRAF (PTA)
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:
Last Name:JEWELL
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 1:2615 E BLACKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-2543
Mailing Address - Country:US
Mailing Address - Phone:812-476-7414
Mailing Address - Fax:
Practice Address - Street 1:404 WEST WILLOW RD
Practice Address - Street 2:
Practice Address - City:DALE
Practice Address - State:IN
Practice Address - Zip Code:47523
Practice Address - Country:US
Practice Address - Phone:812-937-4489
Practice Address - Fax:812-937-7101
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001045A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant