Individual
SOPHIA BAVISOTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
3813 RUBEN SIMPSON CT, FAIRFAX, VA 22033-2435
(703) 973-9686
Mailing address
3813 RUBEN SIMPSON CT, FAIRFAX, VA 22033-2435
(703) 973-9686
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/28/2026
Last updated
04/28/2026
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