Provider Demographics
NPI:1215230362
Name:POWELL, JAQUAY (PT)
Entity Type:Individual
Prefix:
First Name:JAQUAY
Middle Name:
Last Name:POWELL
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 1:20410 CENTURY BLVD
Mailing Address - Street 2:NRH REGIONAL REHAB - SUITE 215
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1186
Mailing Address - Country:US
Mailing Address - Phone:301-540-6140
Mailing Address - Fax:301-540-5190
Practice Address - Street 1:12140 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1932
Practice Address - Country:US
Practice Address - Phone:301-540-6140
Practice Address - Fax:301-540-5190
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist