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NPI Code Detail

MEDICARE: GRANT ROBERTS

MEDICARE: GRANT ROBERTS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1235055146
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRANT ROBERTS
Provider Business Mailing Address
First Line : 721 TABERNACLE LN
Second Line :
City : LYMAN
State : SC
Zip : 29365-9276
Country : US
Telephone Number : 864-518-1503
Fax Number :
Provider Business Practice Location Address
First Line : 9200 UNIVERSITY BLVD
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9121
Country : US
Telephone Number : 843-863-7050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2026
Last Update Date : 06/25/2026

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Directions to “ GRANT ROBERTS ” Practice Location

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