Jason McCully, LPTA

Individual provider Active NPI Physical Therapy Assistant · Gate City, VA

NPI 1922409960 · NPPES record last updated Sep 9, 2014

Key facts

NPI
1922409960
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
2306603393 (VA)
Practice address
150 Dhu St
Gate City, VA 24251-3235
Phone
(276) 386-2416
NPI assigned
Sep 9, 2014
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
2306603393VAMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2306603393 VA Yes

Addresses

Primary practice location

150 Dhu St
Gate City, VA 24251-3235

Mailing address

150 Dhu St
Gate City, VA 24251-3235
Phone (276) 386-2416

Other providers in Gate City, VA

All providers in Gate City, VA · Physical Therapy Assistant in Virginia

Sources for this page

Verify at the official NPI Registry.