Provider Demographics
NPI:1699053702
Name:MERRILL, ELEANOR MIRIAM
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MIRIAM
Last Name:MERRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 TELESTAR CT
Mailing Address - Street 2:SUITE 3PT
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1207
Mailing Address - Country:US
Mailing Address - Phone:571-423-5742
Mailing Address - Fax:571-423-5775
Practice Address - Street 1:6201 CENTREVILLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2626
Practice Address - Country:US
Practice Address - Phone:703-263-2095
Practice Address - Fax:703-263-2098
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist