Healthcare Provider Details

I. General information

NPI: 1407811607
Provider Name (Legal Business Name): RICHARD A. JARRELL JR. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 LANTANA DR
HOCKESSIN DE
19707-8805
US

IV. Provider business mailing address

216 LANTANA DR
HOCKESSIN DE
19707-8805
US

V. Phone/Fax

Practice location:
  • Phone: 302-239-2800
  • Fax: 302-239-7500
Mailing address:
  • Phone: 302-239-2800
  • Fax: 302-239-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000330
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: