Provider Demographics
NPI:1740307578
Name:BEERY, DENA MICHELLE (ATC, EMT)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:MICHELLE
Last Name:BEERY
Suffix:
Gender:F
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 WEEPING WILLOW LN
Mailing Address - Street 2:APT. D
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-9204
Mailing Address - Country:US
Mailing Address - Phone:540-828-0783
Mailing Address - Fax:
Practice Address - Street 1:1800 BUFFALO GAP HWY
Practice Address - Street 2:BUFFALO GAP HIGH SCHOOL
Practice Address - City:SWOOPE
Practice Address - State:VA
Practice Address - Zip Code:24479-2348
Practice Address - Country:US
Practice Address - Phone:540-337-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer