Individual
JASON MCCULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
150 DHU ST, GATE CITY, VA 24251-3235
(276) 386-2416
Mailing address
150 DHU ST, GATE CITY, VA 24251-3235
(276) 386-2416
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306603393
VA
Other
Enumeration date
09/09/2014
Last updated
09/09/2014
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