Healthcare Provider Details

I. General information

NPI: 1780184838
Provider Name (Legal Business Name): MISS BRIANA LYNN REXRODE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16198 L P BAILEY MEMORIAL HWY
NATHALIE VA
24577-3300
US

IV. Provider business mailing address

16198 L P BAILEY MEMORIAL HWY
NATHALIE VA
24577-3300
US

V. Phone/Fax

Practice location:
  • Phone: 434-579-6264
  • Fax: 434-579-6264
Mailing address:
  • Phone:
  • 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: