Provider Demographics
NPI:1740162502
Name:JAKEL, AVA (PT, DPT)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:JAKEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 IVEY ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:GA
Mailing Address - Zip Code:30527-1769
Mailing Address - Country:US
Mailing Address - Phone:678-897-3209
Mailing Address - Fax:
Practice Address - Street 1:4941 S OLD PEACHTREE RD STE D
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3495
Practice Address - Country:US
Practice Address - Phone:678-335-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist