Provider Demographics
NPI:1609186964
Name:ELLWEIN, JESSE CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:CHRISTOPHER
Last Name:ELLWEIN
Suffix:
Gender:M
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:LANDSTUHL REGIONAL MEDICAL CENTER
Mailing Address - Street 2:CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:49637-186-8590
Mailing Address - Fax:
Practice Address - Street 1:BAUMHOLDER HEALTH CLINIC - UNIT 23809
Practice Address - Street 2:CMR 405 BOX #52
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09034
Practice Address - Country:US
Practice Address - Phone:49067-836-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-10984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist