Healthcare Provider Details

I. General information

NPI: 1144994518
Provider Name (Legal Business Name): EMMA RAY HANSON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311B TIMBERLAKE RD
LYNCHBURG VA
24502-7203
US

IV. Provider business mailing address

1735 COVERED BRIDGE RD
GLADYS VA
24554-2884
US

V. Phone/Fax

Practice location:
  • Phone: 434-237-6812
  • Fax:
Mailing address:
  • Phone: 434-610-3965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: