Individual
KELLY ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4428 GLENN ROSE ST, FAIRFAX, VA 22032-1227
(336) 344-1985
Mailing address
4428 GLENN ROSE ST, FAIRFAX, VA 22032-1227
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126001709
VA
Other
Enumeration date
01/31/2013
Last updated
01/31/2013
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