Provider Demographics
NPI:1891567517
Name:PORCEL TELLEZ, JAIME (PT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:PORCEL TELLEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 ARLINGTON BLVD APT 316
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2701
Mailing Address - Country:US
Mailing Address - Phone:703-577-1925
Mailing Address - Fax:
Practice Address - Street 1:6410 ROCKLEDGE DR STE 600
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1844
Practice Address - Country:US
Practice Address - Phone:301-581-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist