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General NPI Number Information
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NPI Number | 1366969321
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Entity Type | Individual
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Provider Name | JEFFERSON STANLEY GRISCAVAGE ATC
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Gender | Male
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 3600 FORBES AVE
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City | PITTSBURGH
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State | PA
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Zip | 15213
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Country | US
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Telephone | 703-232-9666
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Fax |
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Provider Business Mailing Address
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Address Line | 10700 HAMPTON RD
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-2745
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Country | US
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Telephone | 703-250-1102
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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 | 2000032338
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License Number State |
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