MEDICARE: ARTHUR GREGORY POWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist		VA

General Provider Information

NPI Number	:	1235490392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARTHUR GREGORY POWELL

Provider Business Mailing Address
First Line	:	8509 LITTLE RIVER TPKE
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3602
Country	:	US
Telephone Number	:	571-244-1883
Fax Number	:

Provider Business Practice Location Address
First Line	:	8509 LITTLE RIVER TPKE
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3602
Country	:	US
Telephone Number	:	571-244-1883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	06/06/2012

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