Provider Demographics
NPI:1750059267
Name:STANBERRY, BRITTANY ELAINE (AT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ELAINE
Last Name:STANBERRY
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT
Mailing Address - Street 1:8440 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1317
Mailing Address - Country:US
Mailing Address - Phone:719-761-9000
Mailing Address - Fax:
Practice Address - Street 1:EVERGREEN AVE
Practice Address - Street 2:BLDG 3369
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:719-761-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1610910592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer