| Doctor Name: | MR. THOMAS M BURRELL |
| NPI Number: | 1285066076 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 2705009628 |
| Business Practice Address: | 10459 Edgewood Dr King George, VA - 224854817 |
| Business Phone Number: | 5408099414 |
| Business Fax Number: | 5407751374 |
| Mailing Address: | 10459 Edgewood Dr, KING GEORGE |
| State: | VA |
| Postal Code: | 224854817 |
| Phone Number: | 5408099414 |
| Fax Number: | 5407751374 |
| NPI Enumeration Date: | 08/02/2013 |
| NPI Last Update Date: | 08/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WH0202X |
| License Number: | 2705009628 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Home Modifications |
| Taxonomy Definition: | |