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General NPI Number Information
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NPI Number | 1568354272
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Entity Type | Individual
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Provider Name | CHANDLER CARRA GALLANT
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Gender | Female
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 104 HURST LN APT 202
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-6415
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Country | US
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Telephone | 571-251-0645
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Fax |
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Provider Business Mailing Address
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Address Line | 7709 MANOR HOUSE DR
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-2217
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Country | US
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Telephone | 571-251-0645
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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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