Provider Demographics
NPI:1255798641
Name:SALANG, DREANNA WALLACE (ATC)
Entity type:Individual
Prefix:MRS
First Name:DREANNA
Middle Name:WALLACE
Last Name:SALANG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:DREANNA
Other - Middle Name:EL
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:100 BRETTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-4703
Mailing Address - Country:US
Mailing Address - Phone:919-408-6792
Mailing Address - Fax:
Practice Address - Street 1:100 WINTERS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST POINT
Practice Address - State:VA
Practice Address - Zip Code:23181-9534
Practice Address - Country:US
Practice Address - Phone:804-843-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260020842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer