Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306605256 | VA |
N | 225200000X | Physical Therapy Assistant | 5923 | ID |
NPI | 1003383282 |
---|---|
Provider Name | Jessica Harrell-Cooper |
First Address | Alexandria, VA 22315-4712 |
Second Address | Woodbridge, VA 22191-2806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 25/10/2018 |