MEDICARE: DR. BARBARA LONG ED.D, VATL, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	0126000392	VA

General Provider Information

NPI Number	:	1952723744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA LONG ED.D, VATL, ATC

Provider Business Mailing Address
First Line	:	402 E COLLEGE ST
Second Line	:	COLLEGE BOX 152
City	:	BRIDGEWATER
State	:	VA
Zip	:	22812-1511
Country	:	US
Telephone Number	:	540-828-5771
Fax Number	:	540-828-5734

Provider Business Practice Location Address
First Line	:	402 E COLLEGE ST
Second Line	:	COLLEGE BOX 152
City	:	BRIDGEWATER
State	:	VA
Zip	:	22812-1511
Country	:	US
Telephone Number	:	540-828-5771
Fax Number	:	540-828-5734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	01/13/2014

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