Healthcare Provider Details

I. General information

NPI: 1376102459
Provider Name (Legal Business Name): HEALWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GEORGE MASON DR
ARLINGTON VA
22205-3610
US

IV. Provider business mailing address

4201 WILSON BLVD # 110-341
ARLINGTON VA
22203-4417
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-5000
  • Fax:
Mailing address:
  • Phone: 703-662-1603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: KERRY JORDAN
Title or Position: OPERATIONS DIRECTOR
Credential: LMT
Phone: 857-222-0687