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General NPI Number Information
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NPI Number | 1740162502
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Entity Type | Individual
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Provider Name | AVA JAKEL PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 4941 S OLD PEACHTREE RD STE D
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-3495
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Country | US
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Telephone | 678-335-2080
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Fax |
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Provider Business Mailing Address
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Address Line | 111 IVEY ST
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City | CLERMONT
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State | GA
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Zip | 30527-1769
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Country | US
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Telephone | 678-897-3209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT017784
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License Number State | GA
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