Provider Demographics
NPI:1699892398
Name:MANSFIELD, MARTHA ELIZABETH (ATC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:MANSFIELD
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 1:4936 ROSECROFT ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2941
Mailing Address - Country:US
Mailing Address - Phone:757-467-4260
Mailing Address - Fax:
Practice Address - Street 1:5194 CHIEF TRL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2704
Practice Address - Country:US
Practice Address - Phone:757-474-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260000172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer