Provider Demographics
NPI:1922374099
Name:JUMAO-AS, JEANETTE JOSOL (PT)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:JOSOL
Last Name:JUMAO-AS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S 9TH ST
Mailing Address - Street 2:STE 4
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2631
Mailing Address - Country:US
Mailing Address - Phone:765-524-3946
Mailing Address - Fax:317-708-6496
Practice Address - Street 1:430 E CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-5624
Practice Address - Country:US
Practice Address - Phone:574-243-9020
Practice Address - Fax:574-243-5909
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009891A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist