Healthcare Provider Details

I. General information

NPI: 1770003451
Provider Name (Legal Business Name): ASHLEY NICOLE REAMER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15552 GUNDRY AVE
PARAMOUNT CA
90723-3935
US

IV. Provider business mailing address

PO BOX 15
PARAMOUNT CA
90723-0015
US

V. Phone/Fax

Practice location:
  • Phone: 310-986-0945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000028977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: