Provider Demographics
NPI:1447849500
Name:EDWARDS, JANELL (PTA)
Entity type:Individual
Prefix:MS
First Name:JANELL
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 MAYLAND CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1421
Mailing Address - Country:US
Mailing Address - Phone:804-747-0003
Mailing Address - Fax:804-747-0043
Practice Address - Street 1:3514 MAYLAND CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1421
Practice Address - Country:US
Practice Address - Phone:804-747-0003
Practice Address - Fax:804-747-0043
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605225225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant