Charles Lorell Wenger, ATC
Specialist/Technologist, Athletic Trainer in Broadway, VA. Individual provider (NPI-1).
NPI number1164066189
StatusActive
Last updated in NPPESNov 2, 2019
Details
- NPI
- 1164066189
- Entity type
- Individual (NPI-1)
- Name
- Charles Lorell Wenger
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 2, 2019
- Last updated
- Nov 2, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 0126001212 | VA | Yes |
Practice location
269 Gobbler DrBroadway, VA 22815-9483
Phone 540-896-7081
Mailing address
269 Gobbler DrBroadway, VA 22815-9483
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