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General NPI Number Information
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NPI Number | 1437639929
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Entity Type | Individual
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Provider Name | BRITTANY CHWASTIAK
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Gender | Female
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 25921 RIDGE RD
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City | DAMASCUS
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State | MD
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Zip | 20872-1846
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Country | US
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Telephone | 215-804-5713
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Fax |
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Provider Business Mailing Address
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Address Line | 18102 ROLLING MEADOW WAY
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City | OLNEY
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State | MD
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Zip | 20832-1779
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Country | US
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Telephone | 215-804-5713
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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 | A0000994
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License Number State | MD
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