Healthcare Provider Details

I. General information

NPI: 1215601455
Provider Name (Legal Business Name): JEWETT SPORTS & OCCUPATIONAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 CENTRAL AVE
WASHINGTON IN
47501-8537
US

IV. Provider business mailing address

PO BOX 2302
WASHINGTON IN
47501-0942
US

V. Phone/Fax

Practice location:
  • Phone: 812-584-5700
  • Fax:
Mailing address:
  • Phone: 812-584-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDY NICOLE RAMAJ JEWETT
Title or Position: ATHLETIC TRAINER / OWNER
Credential: ATC
Phone: 812-584-5700