Provider Demographics
NPI:1023722832
Name:FELLS, JASON ANDREA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANDREA
Last Name:FELLS
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
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Mailing Address - Street 1:4006 VICTORY BLVD STE J158
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2844
Mailing Address - Country:US
Mailing Address - Phone:757-535-7538
Mailing Address - Fax:757-544-9478
Practice Address - Street 1:1 E MELLEN ST STE 208
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-1709
Practice Address - Country:US
Practice Address - Phone:757-535-7539
Practice Address - Fax:757-544-9478
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0019003913225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist