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General NPI Number Information
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NPI Number | 1508275652
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Entity Type | Individual
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Provider Name | ANDREW WAER ATC
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Gender | Male
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Dates
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Enumeration Date | 08/03/2014
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Last Update Date | 08/03/2014
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Provider Practice Location Address
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Address Line | 1145 KING RD
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City | IMMACULATA
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State | PA
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Zip | 19345-9903
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Country | US
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Telephone | 610-647-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 590 LOWER LANDING RD APT 5F
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City | BLACKWOOD
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State | NJ
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Zip | 08012-4205
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Country | US
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Telephone |
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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 | RT005909
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License Number State | PA
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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 | J3-0000436
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00197100
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License Number State | NJ
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