MEDICARE: LAURA VERELLEN JEWETT DPT

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1467717884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA VERELLEN JEWETT DPT

Provider Business Mailing Address
First Line	:	1800 S JACKSON ST APT 307
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-2183
Country	:	US
Telephone Number	:	206-228-4023
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 42ND AVE SW
Second Line	:	#510
City	:	SEATTLE
State	:	WA
Zip	:	98116-4591
Country	:	US
Telephone Number	:	206-933-1030
Fax Number	:

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

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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