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General NPI Number Information
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NPI Number | 1427516954
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Entity Type | Individual
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Provider Name | CHAD MALLAMO-JANSKI
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Gender | Male
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 136 COLEMAN BUILDING
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City | GREENSBORO
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State | NC
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Zip | 27402
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Country | US
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Telephone | 336-334-5925
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Fax |
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Provider Business Mailing Address
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Address Line | 1727 WALKER AVE APT 201
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City | GREENSBORO
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State | NC
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Zip | 27403-3397
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Country | US
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Telephone | 916-317-7590
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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 |
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License Number State |
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