Basic Information
| Provider Information | |||||||||
| NPI: | 1184978496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOWELL | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | ROSS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSED, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 BOBS CT | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236662800 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4125 IRONBOUND RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231882666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572208383 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2012 | ||||||||
| LastUpdateDate: | 11/08/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0126000810 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.