Provider Demographics
NPI:1720843857
Name:DOLAWAY, JEAN ANN (MS PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:DOLAWAY
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17153 PINTADO PL
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-8590
Mailing Address - Country:US
Mailing Address - Phone:310-877-9860
Mailing Address - Fax:
Practice Address - Street 1:5209 MELVIN AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3800
Practice Address - Country:US
Practice Address - Phone:310-850-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist