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General NPI Number Information
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NPI Number | 1720415771
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Entity Type | Individual
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Provider Name | JUSTIN WALTER SELIGMAN ATC
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Gender | Male
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Dates
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Enumeration Date | 10/06/2013
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Last Update Date | 10/06/2013
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Provider Practice Location Address
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Address Line | 14171 TURNER DR
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City | SMITHFIELD
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State | VA
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Zip | 23430-6675
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Country | US
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Telephone | 540-454-8124
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 SPOTSWOOD AVE APT 206
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City | NORFOLK
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State | VA
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Zip | 23507-1200
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Country | US
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Telephone | 540-454-8124
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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 | 0126001704
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License Number State | VA
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