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General NPI Number Information
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NPI Number | 1750440087
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Entity Type | Individual
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Provider Name | GARRY ANDREW GRANT M.S., A.T.C., CSCS
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 105 GARFIELD AVE MCPHEE PHYSICAL EDUCATION CENTER
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4811
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Country | US
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Telephone | 715-836-3877
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Fax | 715-836-5152
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Provider Business Mailing Address
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Address Line | 3477 SOUTHRIDGE COURT #2
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-836-3877
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Fax | 715-836-5152
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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 | 728-039
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License Number State | WI
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