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General NPI Number Information
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NPI Number | 1962270678
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Entity Type | Individual
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Provider Name | JAIME TEVELSON
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Gender | Female
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 8224 MENTOR AVE STE 114
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City | MENTOR
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State | OH
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Zip | 44060-5743
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Country | US
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Telephone | 330-867-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 180 FOX HOLLOW DR APT 301
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-4195
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Country | US
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Telephone |
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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 | PT020527
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License Number State | OH
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