Provider Demographics
NPI:1427485689
Name:MACDOUGALL, JANELL RANAE (PTA)
Entity type:Individual
Prefix:MRS
First Name:JANELL
Middle Name:RANAE
Last Name:MACDOUGALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JANELL
Other - Middle Name:RANAE
Other - Last Name:EBERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:83 CROSS ROAD LN
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2331
Mailing Address - Country:US
Mailing Address - Phone:540-885-8424
Mailing Address - Fax:
Practice Address - Street 1:101 E STATE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3109
Practice Address - Country:US
Practice Address - Phone:610-444-6350
Practice Address - Fax:610-925-4000
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603503225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant