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General NPI Number Information
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NPI Number | 1134775612
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Entity Type | Individual
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Provider Name | STEPHEN LOUIS GRIGGS ATC
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Gender | Male
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 1560 ORANGE AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-5540
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Country | US
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Telephone | 407-221-3462
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Fax |
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Provider Business Mailing Address
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Address Line | 258 LAKEBREEZE CIR
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City | LAKE MARY
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State | FL
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Zip | 32746-6042
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Country | US
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Telephone | 407-221-3462
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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 | AL451
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License Number State | FL
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