Provider Demographics
NPI:1184079808
Name:WINDELL, JASTIN (DPT)
Entity type:Individual
Prefix:
First Name:JASTIN
Middle Name:
Last Name:WINDELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SPRING GARDEN ST
Mailing Address - Street 2:APT 419
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3940
Mailing Address - Country:US
Mailing Address - Phone:910-494-5583
Mailing Address - Fax:
Practice Address - Street 1:1601 SPRING GARDEN ST
Practice Address - Street 2:APT 419
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3940
Practice Address - Country:US
Practice Address - Phone:910-494-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01515200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist