Provider Demographics
NPI:1629943352
Name:MERRELL, JADE NOEL
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:NOEL
Last Name:MERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 TROPHY CLUB DR APT 353
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-7255
Mailing Address - Country:US
Mailing Address - Phone:281-686-7815
Mailing Address - Fax:
Practice Address - Street 1:90 TROPHY CLUB DR APT 353
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-7255
Practice Address - Country:US
Practice Address - Phone:281-686-7815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1407337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist