Provider Demographics
NPI:1902680366
Name:DECKARD, JOEL THOMAS
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:THOMAS
Last Name:DECKARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SOMERSET PARK DR SE APT 201
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-5696
Mailing Address - Country:US
Mailing Address - Phone:765-993-8392
Mailing Address - Fax:
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DR STE 700
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4529
Practice Address - Country:US
Practice Address - Phone:703-277-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20000189462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer