Provider Demographics
NPI:1366566754
Name:JARRELL, JOSEPH EDWARD JR (LMT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:JARRELL
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:JARRELL
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5402 MACCORKLE AVE SE
Mailing Address - Street 2:BODY TRANQUIL LLC
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2224
Mailing Address - Country:US
Mailing Address - Phone:304-395-3865
Mailing Address - Fax:
Practice Address - Street 1:5402 MACCORKLE AVE SE
Practice Address - Street 2:BODY TRANQUIL LLC
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2224
Practice Address - Country:US
Practice Address - Phone:304-395-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20062167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00182342OtherBLUE CROSS BLUE SHIELD