Healthcare Provider Details

I. General information

NPI: 1245690882
Provider Name (Legal Business Name): WILLIAM FROST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SAINT STEPHENS RD
ALEXANDRIA VA
22304-1727
US

IV. Provider business mailing address

1216 CROTON DR
ALEXANDRIA VA
22308-1801
US

V. Phone/Fax

Practice location:
  • Phone: 703-212-2819
  • Fax:
Mailing address:
  • Phone: 561-789-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000671
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: