Healthcare Provider Details

I. General information

NPI: 1255886289
Provider Name (Legal Business Name): BRITTANY STARR ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY LARAMIE ATC

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 DEERFIELD AVE 312
LANSDOWNE VA
20176-8100
US

IV. Provider business mailing address

1775 N SECTOR CT STE 200
WINCHESTER VA
22601-2859
US

V. Phone/Fax

Practice location:
  • Phone: 703-729-5010
  • Fax:
Mailing address:
  • Phone: 540-542-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126001339
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: