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General NPI Number Information
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NPI Number | 1336745421
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Entity Type | Individual
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Provider Name | DOMINIC BURFORD ATC
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Gender | Male
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 601 F ST NW
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City | WASHINGTON
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State | DC
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Zip | 20004-1605
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Country | US
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Telephone | 814-331-7664
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 DANIA DR
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-3738
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Country | US
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Telephone | 240-291-4497
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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