Healthcare Provider Details

I. General information

NPI: 1780921692
Provider Name (Legal Business Name): CHRISTOPHER DIRK BRILL ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 E PARHAM RD MOB II SUITE 120
RICHMOND VA
23294-4373
US

IV. Provider business mailing address

7650 E PARHAM RD MOB II SUITE 120
RICHMOND VA
23294-4373
US

V. Phone/Fax

Practice location:
  • Phone: 804-545-4952
  • Fax: 804-545-4953
Mailing address:
  • Phone: 804-545-4952
  • Fax: 804-545-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000384
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: