Healthcare Provider Details

I. General information

NPI: 1447849500
Provider Name (Legal Business Name): JANELL EDWARDS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 MAYLAND CT
RICHMOND VA
23233-1421
US

IV. Provider business mailing address

3514 MAYLAND CT
RICHMOND VA
23233-1421
US

V. Phone/Fax

Practice location:
  • Phone: 804-747-0003
  • Fax: 804-747-0043
Mailing address:
  • Phone: 804-747-0003
  • Fax: 804-747-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605225
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: