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General NPI Number Information
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NPI Number | 1134661838
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Entity Type | Individual
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Provider Name | JOHN GRIGSBY A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 11/11/2016
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Last Update Date | 11/11/2016
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Provider Practice Location Address
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Address Line | 750 MORAGA WAY
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City | ORINDA
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State | CA
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Zip | 94563-4330
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Country | US
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Telephone | 925-280-3930
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Fax | 925-280-3931
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Provider Business Mailing Address
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Address Line | 820 AUDREY CT
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City | PLEASANT HILL
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State | CA
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Zip | 94523-1904
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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 | 040502063
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License Number State | CA
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