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PHILIP TYLER GASTRELL
>> Organized Health Care Education/Training Program >> StudentRegistrant NPI Number: 1134574841
Individual Registrant: PHILIP TYLER GASTRELL
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
2691 SOUTHERN HILLS CT NORTH GARDEN, VA 22959-1640 US
Tel: 703-405-4178 Fax: --
Tel: 703-405-4178 Fax: --
Contact information for business:
2691 SOUTHERN HILLS CT NORTH GARDEN, VA 22959-1640 US
Tel: 703-405-4178 Fax: --
Tel: 703-405-4178 Fax: --
Registration Information:
NPI: 1134574841
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 390200000X | Student Organized Health Care Education/Training Program |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
