MEDICARE: BRITTANY CHWASTIAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	A0000994	MD

General Provider Information

NPI Number	:	1437639929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY CHWASTIAK

Provider Business Mailing Address
First Line	:	18102 ROLLING MEADOW WAY
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-1779
Country	:	US
Telephone Number	:	215-804-5713
Fax Number	:

Provider Business Practice Location Address
First Line	:	25921 RIDGE RD
Second Line	:
City	:	DAMASCUS
State	:	MD
Zip	:	20872-1846
Country	:	US
Telephone Number	:	215-804-5713
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	08/15/2018

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Directions to “ BRITTANY CHWASTIAK ” Practice Location

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