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General NPI Number Information
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NPI Number | 1144875303
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Entity Type | Individual
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Provider Name | GILLIAN STREIT MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 566 BROWNSON RD
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City | ANNAPOLIS
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State | MD
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Zip | 21402-5006
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Country | US
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Telephone | 712-269-8374
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Fax |
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Provider Business Mailing Address
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Address Line | 251 5TH ST
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City | MANILLA
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State | IA
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Zip | 51454-7628
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Country | US
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Telephone | 712-269-8374
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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 | A0001552
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096005411
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License Number State | IL
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