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General NPI Number Information
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NPI Number | 1093859068
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Entity Type | Individual
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Provider Name | GREG A PENDLEY ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1901 LAKESHORE DR S
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City | HOMEWOOD
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State | AL
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Zip | 35209-6730
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Country | US
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Telephone | 205-871-9663
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Fax | 205-879-0879
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Provider Business Mailing Address
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Address Line | 2274 WHITE WAY
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City | HOOVER
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State | AL
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Zip | 35226-3126
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Country | US
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Telephone | 205-822-8860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 078
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License Number State | AL
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