Provider Demographics
NPI:1942509781
Name:HEWITT, JERUEL G III (DS, MAT, MMP, LMT)
Entity Type:Individual
Prefix:MR
First Name:JERUEL
Middle Name:G
Last Name:HEWITT
Suffix:III
Gender:M
Credentials:DS, MAT, MMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N WILMOT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2618
Mailing Address - Country:US
Mailing Address - Phone:520-551-3497
Mailing Address - Fax:
Practice Address - Street 1:310 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2618
Practice Address - Country:US
Practice Address - Phone:520-551-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-06009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist