Dakari Branch
Individual provider Active NPI Athletic Trainer · Forest, VA
NPI 1265218523 · NPPES record last updated Sep 4, 2023
Key facts
- NPI
- 1265218523
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 1012 Westyn Terrace Loop Apt 102
Forest, VA 24551-5058 - Phone
- (804) 704-5808
- NPI assigned
- Sep 4, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
1012 Westyn Terrace Loop Apt 102
Forest, VA 24551-5058
Mailing address
1012 Westyn Terrace Loop Apt 102
Forest, VA 24551-5058
Phone (804) 704-5808
Other providers in Forest, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2023. 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.