Healthcare Provider Details

I. General information

NPI: 1396053393
Provider Name (Legal Business Name): HEATHER JEWELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER BOWLING

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

20410 CENTURY BLVD NRH REGIONAL REHAB - SUITE 215
GERMANTOWN MD
20874-1186
US

V. Phone/Fax

Practice location:
  • Phone: 301-540-6140
  • Fax: 301-540-5190
Mailing address:
  • Phone: 301-540-6140
  • Fax: 301-540-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: