Provider Demographics
NPI:1336494723
Name:PREWITT, JENNIFER ANNA PHAN (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNA PHAN
Last Name:PREWITT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANNA
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:16030 BOTHELL EVERETT HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1273
Mailing Address - Country:US
Mailing Address - Phone:425-745-4910
Mailing Address - Fax:425-338-5709
Practice Address - Street 1:16030 BOTHELL EVERETT HWY STE 200
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1273
Practice Address - Country:US
Practice Address - Phone:425-745-4910
Practice Address - Fax:425-338-5709
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT391972251X0800X
WAPT60612231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic