Healthcare Provider Details

I. General information

NPI: 1922499896
Provider Name (Legal Business Name): AARON EPPLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 GRASSFIELD PKWY SUITE 1
CHESAPEAKE VA
23322-7465
US

IV. Provider business mailing address

817 KEMP MEADOW DR
CHESAPEAKE VA
23320-5027
US

V. Phone/Fax

Practice location:
  • Phone: 757-738-1325
  • Fax:
Mailing address:
  • Phone: 757-709-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number120502091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: