Basic Information
| Provider Information | |||||||||
| NPI: | 1013334119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERS | ||||||||
| FirstName: | ANDI | ||||||||
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| Credential: | MSAT, LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 THOMAS JOHNSON DR | ||||||||
| Address2: | STE. 180 | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016207478 | ||||||||
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| Practice Location | |||||||||
| Address1: | 81 W FREDERICK ST | ||||||||
| Address2: | |||||||||
| City: | WALKERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217938216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402367400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2014 | ||||||||
| LastUpdateDate: | 03/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | A0000513 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.