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General NPI Number Information
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NPI Number | 1104509553
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Entity Type | Individual
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Provider Name | DONNELL ANDREW ATHERLEY MT
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Gender | Male
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 108 S COLUMBUS ST STE 300
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3080
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Country | US
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Telephone | 703-403-7778
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Fax |
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Provider Business Mailing Address
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Address Line | 2331 SPRINGDALE LN
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City | WALDORF
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State | MD
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Zip | 20603-3240
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Country | US
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Telephone | 301-356-6729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT1698
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License Number State | DC
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