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General NPI Number Information
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NPI Number | 1730592775
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Entity Type | Individual
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Provider Name | MATTIE ECKERMAN
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Gender | Female
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Dates
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Enumeration Date | 06/07/2014
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Last Update Date | 06/07/2014
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Provider Practice Location Address
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Address Line | 2500 OLD WESTMINSTER PIKE
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City | FINKSBURG
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State | MD
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Zip | 21048-1824
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Country | US
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Telephone | 443-310-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 14 MISTY HOLLOW CT
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City | PHOENIX
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State | MD
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Zip | 21131-1313
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Country | US
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Telephone | 443-310-0050
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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 | A0000029
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License Number State | MD
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