Healthcare Provider Details

I. General information

NPI: 1497878227
Provider Name (Legal Business Name): CARRIE CHEELEY GIACOFEI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE SUSAN CHEELEY ATC

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BOULDERS PKWY SUITE 110
RICHMOND VA
23225
US

IV. Provider business mailing address

3108 OSBORNE RD
CHESTER VA
23831
US

V. Phone/Fax

Practice location:
  • Phone: 804-560-6500
  • Fax:
Mailing address:
  • Phone: 804-399-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000869
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: