Healthcare Provider Details

I. General information

NPI: 1174553705
Provider Name (Legal Business Name): ANNA MARIE SEDORY MS, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIE AUGUST MS,ATC,CSCS

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 INVESTIGATION PKWY
QUANTICO VA
22134-5173
US

IV. Provider business mailing address

3713 ALBERTA DR
FREDERICKSBURG VA
22408-7714
US

V. Phone/Fax

Practice location:
  • Phone: 703-632-5078
  • Fax:
Mailing address:
  • Phone: 562-237-1509
  • 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: