Basic Information
| Provider Information | |||||||||
| NPI: | 1376102459 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALWELL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 WILSON BLVD # 110-341 | ||||||||
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| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222034417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036621603 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1701 N GEORGE MASON DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222053610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035585000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2019 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | JORDAN | ||||||||
| AuthorizedOfficialFirstName: | KERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8572220687 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.