Provider Demographics
NPI:1104509553
Name:ATHERLEY, DONNELL ANDREW (MT)
Entity type:Individual
Prefix:MR
First Name:DONNELL
Middle Name:ANDREW
Last Name:ATHERLEY
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 SPRINGDALE LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3240
Mailing Address - Country:US
Mailing Address - Phone:301-356-6729
Mailing Address - Fax:
Practice Address - Street 1:108 S COLUMBUS ST STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3080
Practice Address - Country:US
Practice Address - Phone:703-403-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT1698225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist