Provider Demographics
NPI:1407811607
Name:JARRELL, RICHARD A JR (PTA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:JARRELL
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8805
Mailing Address - Country:US
Mailing Address - Phone:302-239-2800
Mailing Address - Fax:302-239-7500
Practice Address - Street 1:216 LANTANA DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8805
Practice Address - Country:US
Practice Address - Phone:302-239-2800
Practice Address - Fax:302-239-7500
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000330225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant