Individual
KENNEDY ALXYA LOGSDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
100 DR. GASMICK LANE, FROSTBURG, MD 21532
(301) 268-2700
Mailing address
100 DR. GASMICK LANE, FROSTBURG, MD 21532
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A00984
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A00984
MARYLAND BOARD OF PHYSICIANS
MD
Enumeration date
09/12/2017
Last updated
09/12/2017
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