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General NPI Number Information
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NPI Number | 1598785461
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Entity Type | Individual
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Provider Name | ANDREW MARX FORD ATC
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 1423 WALTHAM LN
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-7763
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Country | US
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Telephone | 617-838-6667
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 JAMES RIVER TRCE
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City | LANGLEY AFB
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State | VA
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Zip | 23665-2419
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Country | US
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Telephone | 617-838-6667
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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 | 003801
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License Number State | OH
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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 | 0126003387
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License Number State | VA
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