Healthcare Provider Details

I. General information

NPI: 1265844526
Provider Name (Legal Business Name): PRECIOUS BARNES ATC, MS, ART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 POTOMAC SCHOOL RD
MC LEAN VA
22101-2350
US

IV. Provider business mailing address

610 N IMBODEN ST APT 401
ALEXANDRIA VA
22304-5498
US

V. Phone/Fax

Practice location:
  • Phone: 703-356-4100
  • Fax:
Mailing address:
  • Phone: 757-343-7427
  • 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: