MEDICARE: JEFF SHAWN CEMEL PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	3132	TN

General Provider Information

NPI Number	:	1164769048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF SHAWN CEMEL PTA

Provider Business Mailing Address
First Line	:	8823 PRODUCTION LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6511
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	210 WALMART DR STE 100
Second Line	:
City	:	SODDY DAISY
State	:	TN
Zip	:	37379-5022
Country	:	US
Telephone Number	:	423-332-9490
Fax Number	:	423-332-3817

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	01/11/2013

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