Individual
BREE CLEMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, ATC, LAT
Contact information
Practice address
5838 HARBOUR VIEW BLVD, SUFFOLK, VA 23435-2663
(757) 879-1621
Mailing address
5838 HARBOUR VIEW BLVD, SUFFOLK, VA 23435-2663
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126001810
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0126001810
VIRGINIA LICENSURE
—
01
—
2000004854
BOARD OF CERTIFICATIOIN
VA
Enumeration date
10/02/2013
Last updated
10/02/2013
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