Individual
MS. JENNIFER LYNN SEWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT, ATC
Contact information
Practice address
620 RED TABLE ROAD, SUITE A, GYPSUM, CO 81637
(970) 306-8609
Mailing address
PO BOX 13, EDWARDS, CO 81632-0013
(970) 306-8609
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10254
CO
225100000X
Physical Therapist
10764
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36134600
—
WI
Enumeration date
02/14/2007
Last updated
10/19/2012
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