MEDICARE: KALOB JEWETT

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	:	1821948209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALOB JEWETT

Provider Business Mailing Address
First Line	:	6050 TACOMA MALL BLVD STE 300
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-6828
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9521 GRAVELLY LAKE DR SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-1513
Country	:	US
Telephone Number	:	253-983-9395
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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