Healthcare Provider Details

I. General information

NPI: 1275321556
Provider Name (Legal Business Name): JEWEL PHYSICAL THERAPY AND WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 ROSEHEDGE DR
LA MESA CA
91942-9519
US

IV. Provider business mailing address

4960 ROSEHEDGE DR
LA MESA CA
91942-9519
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-3935
  • Fax:
Mailing address:
  • Phone: 980-785-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN KNIGHTLY CAMPBELL
Title or Position: OWNER
Credential: PT, DPT
Phone: 413-281-4305