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General NPI Number Information
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NPI Number | 1740899962
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Entity Type | Individual
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Provider Name | KENNETH ANDREW GREENFIELD ATC
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Gender | Male
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 230 N. CAMDEN RD.
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City | WINGATE
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State | NC
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Zip | 28174
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Country | US
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Telephone | 704-233-8193
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Fax |
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Provider Business Mailing Address
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Address Line | 6 BISCAYNE PL
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City | STERLING
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State | VA
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Zip | 20164-1105
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Country | US
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Telephone | 571-236-5147
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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 | 5788
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License Number State | FL
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