Provider Demographics
NPI:1124122296
Name:AMBROSE, DAVID GEORGE (BS ATC PTA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GEORGE
Last Name:AMBROSE
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Gender:M
Credentials:BS ATC PTA
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Mailing Address - Street 1:1414 RIGDON ROAD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1613
Mailing Address - Country:US
Mailing Address - Phone:410-557-7590
Mailing Address - Fax:
Practice Address - Street 1:8322 BELLONA AVE
Practice Address - Street 2:TOWSON SPORTS MEDICINE
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-337-8847
Practice Address - Fax:410-337-5189
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDA2434225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant