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General NPI Number Information
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NPI Number | 1124083654
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Entity Type | Individual
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Provider Name | JASON ALAN MORRELL P.T.A.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 209 ELDEN ST SUITE 106
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City | HERNDON
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State | VA
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Zip | 20170-4852
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Country | US
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Telephone | 703-481-3551
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Fax | 703-481-3276
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Provider Business Mailing Address
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Address Line | 22278 GREAT TRAIL TER
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City | STERLING
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State | VA
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Zip | 20164
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Country | US
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Telephone | 703-450-1288
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1394
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License Number State | VA
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