Provider Demographics
NPI:1215205950
Name:YAMRUS, RAY JR (MS, VATL, ATC)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:YAMRUS
Suffix:JR
Gender:M
Credentials:MS, VATL, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 UNIVERSITY DR
Mailing Address - Street 2:INTERCOLLEGIATE ATHLETICS - MS 3A5
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4422
Mailing Address - Country:US
Mailing Address - Phone:703-993-3280
Mailing Address - Fax:703-993-3360
Practice Address - Street 1:4400 UNIVERSITY DR
Practice Address - Street 2:INTERCOLLEGIATE ATHLETICS - MS 3A5
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4422
Practice Address - Country:US
Practice Address - Phone:703-993-3280
Practice Address - Fax:703-993-3360
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126 0003852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer