Individual
JELANI BACKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
402 E COLLEGE ST, BRIDGEWATER, VA 22812-1511
(540) 828-8000
Mailing address
402 E COLLEGE ST, BRIDGEWATER, VA 22812-1511
(540) 828-8000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/18/2022
Last updated
11/18/2022
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