Provider Demographics
NPI:1336708841
Name:SOWELLS, JASMINE AIYANNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:AIYANNA
Last Name:SOWELLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-4537
Mailing Address - Country:US
Mailing Address - Phone:210-265-9852
Mailing Address - Fax:
Practice Address - Street 1:5161 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-4390
Practice Address - Country:US
Practice Address - Phone:214-633-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-08
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1318267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist