Provider Demographics
NPI:1538565056
Name:EWELL, NEONELA
Entity type:Individual
Prefix:
First Name:NEONELA
Middle Name:
Last Name:EWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 BOSTON ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4814
Mailing Address - Country:US
Mailing Address - Phone:410-522-6978
Mailing Address - Fax:
Practice Address - Street 1:2809 BOSTON ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4814
Practice Address - Country:US
Practice Address - Phone:410-522-6978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4138225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant