Provider Demographics
NPI:1326561226
Name:SYMONS, STEPHANIE (ATC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SYMONS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WHALEBACK LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-5470
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24164 BELLEAU AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5106
Practice Address - Country:US
Practice Address - Phone:801-455-9806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer