Individual
MISS STACY L VITEK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ATC/CPT
Contact information
Practice address
2007 MEADE PKWY, SUFFOLK, VA 23434-4259
(757) 539-6300
(757) 539-0704
Mailing address
305 DOCK CT, SUFFOLK, VA 23435-2779
(757) 483-0144
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000956
VA
Other
Enumeration date
02/27/2006
Last updated
07/08/2007
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