Provider Demographics
NPI:1962608232
Name:EWING, JENNIFER SUZANNE (CPTA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:EWING
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SEQUOIA ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4634
Mailing Address - Country:US
Mailing Address - Phone:620-669-3709
Mailing Address - Fax:
Practice Address - Street 1:400 S BUHLER RD
Practice Address - Street 2:SUNSHINE MEADOWS
Practice Address - City:BUHLER
Practice Address - State:KS
Practice Address - Zip Code:67522-8133
Practice Address - Country:US
Practice Address - Phone:620-543-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1401775225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant