Active NPI
Terry E Walburn II, MSED., ATC, VATL
- Athletic Trainer
- Chesapeake, VA
National Provider Identifier
1306233689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0126000110
- Practice address
- 409 Supplejack CT
Chesapeake, VA 23320-9233 - Phone
- (757) 548-5815
- NPI assigned
- Apr 23, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0126000110 | VA | Primary |
Addresses
Primary practice location
409 Supplejack CT
Chesapeake, VA 23320-9233
Mailing address
409 Supplejack CT
Chesapeake, VA 23320-9233
Phone (757) 548-5815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0126000110 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429747200000",
"number": "1306233689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 SUPPLEJACK CT",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233209233",
"telephone_number": "757-548-5815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 SUPPLEJACK CT",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233209233",
"telephone_number": "757-548-5815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALBURN",
"first_name": "TERRY",
"middle_name": "E",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "MSED., ATC, VATL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-23",
"last_updated": "2015-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126000110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.