Healthcare Provider Details

I. General information

NPI: 1245145994
Provider Name (Legal Business Name): RAYANNE MARIE JARRELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 GAS HOUSE PIKE STE U
FREDERICK MD
21701-4974
US

IV. Provider business mailing address

7180 PROCLAMATION PL
FREDERICK MD
21703-2980
US

V. Phone/Fax

Practice location:
  • Phone: 240-651-0149
  • Fax:
Mailing address:
  • Phone: 850-693-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6265
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: