Charles Lorell Wenger, ATC
Individual provider Active NPI Athletic Trainer · Broadway, VA
NPI 1164066189 · NPPES record last updated Nov 2, 2019
Key facts
- NPI
- 1164066189
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 0126001212 (VA)
- Practice address
- 269 Gobbler Dr
Broadway, VA 22815-9483 - Phone
- (540) 896-7081
- NPI assigned
- Nov 2, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0126001212 | VA | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0126001212 | VA | Yes |
Addresses
Primary practice location
269 Gobbler Dr
Broadway, VA 22815-9483
Mailing address
269 Gobbler Dr
Broadway, VA 22815-9483
Other providers in Broadway, VA
- Kristee Jo Rosenow Trumbo
- Valley Medical Supplies, LLC
- Adam M Vannortwick
- Kathryn Walkley
- Laurie M Weese
- Brynn Whetzel
- Colleen M Whiteford
- William F Whiteford
- Erica Wojciechowski
- Staci Woods
All providers in Broadway, VA · Athletic Trainer in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.