MEDICARE: DEBORAH BECK CORBATTO ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	0126000596	VA

General Provider Information

NPI Number	:	1801861232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH BECK CORBATTO ATC

Provider Business Mailing Address
First Line	:	10810 STANHOPE PL
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22032-2935
Country	:	US
Telephone Number	:	703-278-8929
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 UNIVERSITY DR
Second Line	:	GEORGE MASON UNIVERSITY
City	:	FAIRFAX
State	:	VA
Zip	:	22030-4422
Country	:	US
Telephone Number	:	703-993-3277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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