Healthcare Provider Details

I. General information

NPI: 1770972663
Provider Name (Legal Business Name): SARA LAUREN GRALITZER MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOBLE AVE
VAN NUYS CA
91405-3796
US

IV. Provider business mailing address

6915 NOBLE AVE
VAN NUYS CA
91405
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-6600
  • Fax:
Mailing address:
  • Phone: 818-901-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: