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NPI Code Detail

MEDICARE: MARAH JONES ATC

MEDICARE: MARAH JONES ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer0126002519VA

General Provider Information

NPI Number : 1619428612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARAH JONES ATC
Provider Business Mailing Address
First Line : 518 YORKTOWNE PL
Second Line :
City : WINCHESTER
State : VA
Zip : 22601-3449
Country : US
Telephone Number : 540-255-2965
Fax Number :
Provider Business Practice Location Address
First Line : 1460 UNIVERSITY DR
Second Line :
City : WINCHESTER
State : VA
Zip : 22601-5100
Country : US
Telephone Number : 540-542-6505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2016
Last Update Date : 10/14/2016

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