Individual
BREANNA DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBA, VATL, ATC
Contact information
Practice address
812 THOMPSON DR, C/O BRE DAVENPORT, ABINGDON, VA 24210-2346
(276) 206-6729
Mailing address
10774 FOREST HILL DR, GLADE SPRING, VA 24340-5246
(276) 206-6729
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126001832
VA
Other
Enumeration date
10/13/2016
Last updated
10/13/2016
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