Healthcare Provider Details

I. General information

NPI: 1023072311
Provider Name (Legal Business Name): JOHN GLYN PIPER ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S JACKSON SQ
JACKSON MI
49201-2240
US

IV. Provider business mailing address

3031 MOSHERVILLE RD
JONESVILLE MI
49250
US

V. Phone/Fax

Practice location:
  • Phone: 517-841-7497
  • Fax: 517-841-7496
Mailing address:
  • Phone: 269-352-7645
  • Fax: 517-841-7496

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: