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General NPI Number Information
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NPI Number | 1093894255
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Entity Type | Individual
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Provider Name | AMY L GRABER ATC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 235 S 33RD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3807
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Country | US
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Telephone | 215-898-2822
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Fax |
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Provider Business Mailing Address
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Address Line | 1554 E BERKS ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-2802
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Country | US
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Telephone |
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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 | RT003497
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License Number State | PA
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