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General NPI Number Information
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NPI Number | 1225440753
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Entity Type | Individual
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Provider Name | ALLISON GARDINER LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 2410 EVERGREEN RD STE 100
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City | GAMBRILLS
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State | MD
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Zip | 21054-1979
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Country | US
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Telephone | 215-450-8978
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 EVERGREEN RD STE 100
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City | GAMBRILLS
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State | MD
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Zip | 21054-1979
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Country | US
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Telephone | 215-450-8978
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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 | 0126002340
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License Number State | VA
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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 | A0001307
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License Number State | MD
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