MEDICARE: MRS. ALEXANDRA R PUMPHREY ATC

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	0126001934	VA

General Provider Information

NPI Number	:	1962044313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDRA R PUMPHREY ATC

Provider Business Mailing Address
First Line	:	9705 RANSOM HILLS TER
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-3570
Country	:	US
Telephone Number	:	804-922-6007
Fax Number	:

Provider Business Practice Location Address
First Line	:	9705 RANSOM HILLS TER
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-3570
Country	:	US
Telephone Number	:	804-922-6007
Fax Number	:

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

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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