Provider Demographics
NPI:1205864618
Name:JARRELL, SHARLEEN J (PT)
Entity Type:Individual
Prefix:
First Name:SHARLEEN
Middle Name:J
Last Name:JARRELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 US HIGHWAY 51 N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1535
Mailing Address - Country:US
Mailing Address - Phone:901-873-3773
Mailing Address - Fax:901-873-3780
Practice Address - Street 1:8507 US HIGHWAY 51 N
Practice Address - Street 2:SUITE 107
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1535
Practice Address - Country:US
Practice Address - Phone:901-873-3773
Practice Address - Fax:901-873-3780
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000006458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446538Medicare ID - Type Unspecified