Healthcare Provider Details

I. General information

NPI: 1174652895
Provider Name (Legal Business Name): MARK THOMAS GARNAAT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 12/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S MAIN
CEDAR SPRINGS MI
49319-8925
US

IV. Provider business mailing address

14699 IVORYSTONE DR NE
CEDAR SPRINGS MI
49319-7803
US

V. Phone/Fax

Practice location:
  • Phone: 616-696-6555
  • Fax:
Mailing address:
  • Phone:
  • 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: