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General NPI Number Information
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NPI Number | 1275055717
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Entity Type | Individual
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Provider Name | JULIANNE LO GRASSO ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 07/15/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 7165 MARSHALL CORNER RD
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City | POMFRET
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State | MD
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Zip | 20675-3047
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Country | US
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Telephone | 240-682-6914
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Fax |
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Provider Business Mailing Address
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Address Line | 2795 TRUMPETER CT
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City | WALDORF
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State | MD
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Zip | 20601-2625
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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 | A0000883
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License Number State | MD
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