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General NPI Number Information
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NPI Number | 1023531944
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Entity Type | Individual
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Provider Name | ANDREW MICHAEL MCNELLIS ATC
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Gender | Male
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 07/23/2017
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Provider Practice Location Address
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Address Line | 300 CUTHBERT BLVD
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City | CHERRY HILL
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State | NJ
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Zip | 08002-2904
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Country | US
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Telephone | 856-663-2247
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Fax | 856-661-0632
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Provider Business Mailing Address
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Address Line | 1008 MICAWBER DR
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-2139
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Country | US
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Telephone | 856-340-9524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00240200
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License Number State | NJ
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