Individual provider · NPI-1

Crystal Rene Ambersley, ATC, LAT

Specialist/Technologist, Athletic Trainer · Bowie, MD

NPI number1295325108
StatusActive
Last updated in NPPESMar 29, 2024

Details

NPI
1295325108
Entity type
Individual (NPI-1)
Name
Crystal Rene Ambersley
Credential
ATC, LAT
Sex
Female
Sole proprietor
No
Enumeration date
Jan 25, 2021
Certification date
Mar 29, 2024
Last updated
Mar 29, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic TrainerA0001485MDYes
390200000X Student in an Organized Health Care Education/Training Program–MD

Practice location

14000 Jericho Park Rd
Bowie, MD 20715-3319

Phone 580-919-6424

Mailing address

2319 Meadows Ct
Odenton, MD 21113-4078

Phone 580-919-6424

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