Individual
DR. JATIN P AMBEGAONKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD ATC OT CSCS
Contact information
Practice address
10900 UNIVERSITY BLVD, MS 4E5 - 208 C BULL RUN HALL, MANASSAS, VA 20110-2201
(703) 993-2123
Mailing address
5290 JULE STAR DR, CENTREVILLE, VA 20120-3006
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126001129
VA
Other
Enumeration date
07/21/2010
Last updated
07/21/2010
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