Individual
MR. TIM M BANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1092 WINTER WREN ST, GRUNDY, VA 24614-5770
(540) 632-9184
Mailing address
1092 WINTER WREN ST, GRUNDY, VA 24614-5770
(540) 632-9184
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000341
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
812463
NATIONAL ATHLETIC TRAINERS ASSOCIATION BOC
—
Enumeration date
03/17/2022
Last updated
03/17/2022
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