Healthcare Provider Details

I. General information

NPI: 1730096041
Provider Name (Legal Business Name): ALEXANDRA GABRIELLE MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14815 VIEWCREST RD SW
CUMBERLAND MD
21502-5855
US

IV. Provider business mailing address

14815 VIEWCREST RD SW
CUMBERLAND MD
21502-5855
US

V. Phone/Fax

Practice location:
  • Phone: 301-697-0181
  • Fax:
Mailing address:
  • Phone: 301-697-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: