Provider Demographics
NPI:1548531650
Name:JEWELL, MARTHA JEANE (PT PHD)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JEANE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:PT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 CONCANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6577
Mailing Address - Country:US
Mailing Address - Phone:925-443-9030
Mailing Address - Fax:
Practice Address - Street 1:160 WINESAP DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5907
Practice Address - Country:US
Practice Address - Phone:925-516-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist