Healthcare Provider Details

I. General information

NPI: 1801463518
Provider Name (Legal Business Name): BRITTANY ERIN VERGE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 PINNEY ST APT 37
ELLINGTON CT
06029-3825
US

IV. Provider business mailing address

26 PINNEY ST APT 37
ELLINGTON CT
06029-3825
US

V. Phone/Fax

Practice location:
  • Phone: 802-323-6118
  • Fax:
Mailing address:
  • Phone: 802-323-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1529
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: