Provider Demographics
NPI:1053959684
Name:GARRISON, DONTONIO (LAT, ATC)
Entity type:Individual
Prefix:
First Name:DONTONIO
Middle Name:
Last Name:GARRISON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MISTY CV APT A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1305
Mailing Address - Country:US
Mailing Address - Phone:336-906-3342
Mailing Address - Fax:
Practice Address - Street 1:100 E QUEEN ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23668-0108
Practice Address - Country:US
Practice Address - Phone:336-906-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260031402081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine