Individual
MISS JESSICA SHANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, VATL
Contact information
Practice address
15721 FOREST PARK DR, FOREST PARK HIGH SCHOOL, WOODBRIDGE, VA 22193-3180
(703) 583-3200
(703) 583-6867
Mailing address
4269 NORMANDY CT, FREDERICKSBURG, VA 22408-3909
(703) 906-5103
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000201
VA
Other
Enumeration date
07/15/2014
Last updated
07/15/2014
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