Basic Information
| Provider Information | |||||||||
| NPI: | 1528575487 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | JAY SCOTT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 OLIVE CHAPEL RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275028587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195338758 | ||||||||
| FaxNumber: | 9195353271 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 S GLENBURNIE RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285625227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523025200 | ||||||||
| FaxNumber: | 2523022191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2018 | ||||||||
| LastUpdateDate: | 01/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P17636 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.