Provider Demographics
NPI:1942337779
Name:BURRELL, JOHN FITZGERALD (ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FITZGERALD
Last Name:BURRELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43144 HUNTSMAN SQ
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-5092
Mailing Address - Country:US
Mailing Address - Phone:703-850-4438
Mailing Address - Fax:
Practice Address - Street 1:21300 REDSKIN PARK DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6100
Practice Address - Country:US
Practice Address - Phone:703-726-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260007532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer