Provider Demographics
NPI:1124418421
Name:DCPS ATHLETIC DEPARTMENT
Entity Type:Organization
Organization Name:DCPS ATHLETIC DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:JOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,ATC
Authorized Official - Phone:202-306-0669
Mailing Address - Street 1:1537 41ST ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6003
Mailing Address - Country:US
Mailing Address - Phone:202-306-0669
Mailing Address - Fax:
Practice Address - Street 1:1537 41ST ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6003
Practice Address - Country:US
Practice Address - Phone:202-306-0669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty