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General NPI Number Information
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NPI Number | 1053542969
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Entity Type | Individual
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Provider Name | BENJAMIN MICHAEL MCANDREWS MS, ATC, NASM-CES
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Gender | Male
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 828 HEALTHY WAY STE 105
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-7958
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Country | US
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Telephone | 757-463-2540
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Fax | 757-463-2554
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Provider Business Mailing Address
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Address Line | 4608 GALEFORCE CT APT 203
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-2041
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Country | US
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Telephone | 757-619-5213
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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 | 0126001207
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License Number State | VA
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