Provider Demographics
NPI:1821586967
Name:HEWKO, DARRELL WILLIAM (PT)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:WILLIAM
Last Name:HEWKO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 EASTGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1584
Mailing Address - Country:US
Mailing Address - Phone:513-977-2153
Mailing Address - Fax:513-888-8784
Practice Address - Street 1:4452 EASTGATE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1584
Practice Address - Country:US
Practice Address - Phone:513-977-2153
Practice Address - Fax:513-888-8784
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-7405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist