Individual
BREANNA FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13397 PACKARD DR, WOODBRIDGE, VA 22193-3901
(571) 991-1290
Mailing address
13397 PACKARD DR, WOODBRIDGE, VA 22193-3901
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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