Individual
LACEY REBECCA DUNGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
10523 MAIN ST, FAIRFAX, VA 22030-3310
(703) 380-8141
Mailing address
4220 RALEIGH AVE, APT 202, ALEXANDRIA, VA 22304-5338
(610) 348-8995
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002412
VA
Other
Enumeration date
01/20/2016
Last updated
01/20/2016
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