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General NPI Number Information
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NPI Number | 1942337779
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Entity Type | Individual
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Provider Name | JOHN FITZGERALD BURRELL ATC
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21300 REDSKIN PARK DR
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City | ASHBURN
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State | VA
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Zip | 20147-6100
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Country | US
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Telephone | 703-726-7230
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Fax |
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Provider Business Mailing Address
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Address Line | 43144 HUNTSMAN SQ
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City | BROADLANDS
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State | VA
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Zip | 20148-5092
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Country | US
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Telephone | 703-850-4438
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126000753
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License Number State | VA
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