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General NPI Number Information
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NPI Number | 1558607986
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Entity Type | Individual
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Provider Name | ANGELA COLEMAN WITT ATC
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Gender | Female
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 1971 UNIVERSITY BLVD ICE CENTER
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City | LYNCHBURG
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State | VA
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Zip | 24502-2269
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Country | US
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Telephone | 434-592-6390
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Fax | 434-522-0549
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Provider Business Mailing Address
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Address Line | 1971 UNIVERSITY BLVD ICE CENTER
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City | LYNCHBURG
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State | VA
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Zip | 24502-2269
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Country | US
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Telephone | 434-592-6390
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Fax | 434-522-0549
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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 | 0126000348
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License Number State | VA
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