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General NPI Number Information
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NPI Number | 1164819660
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Entity Type | Organization
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Legal Business Name | THE POTOMAC SCHOOL
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 1301 POTOMAC SCHOOL RD
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City | MC LEAN
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State | VA
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Zip | 22101-2350
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Country | US
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Telephone | 703-489-7632
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 POTOMAC SCHOOL RD
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City | MC LEAN
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State | VA
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Zip | 22101-2350
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Country | US
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Telephone | 703-489-7632
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Fax |
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Authorized Official
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Title or Position | HEAD ATHLETIC TRAINER
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Name | MR. TERRENCE CUMMINGS
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Credential | L.A.T.C.
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Telephone | 703-489-7632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126000115
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License Number State | VA
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