MEDICARE: GRANT SMITH

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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1245166990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT SMITH

Provider Business Mailing Address
First Line	:	1 E SHERIDAN AVE
Second Line	:
City	:	ANNVILLE
State	:	PA
Zip	:	17003-1417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N COLLEGE AVE
Second Line	:
City	:	ANNVILLE
State	:	PA
Zip	:	17003-1404
Country	:	US
Telephone Number	:	717-867-6848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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