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General NPI Number Information
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NPI Number | 1871522367
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Entity Type | Individual
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Provider Name | GARY GLYNN STILES JR. ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 1890 W COUNTY ROAD 419 SUITE 1000
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City | OVIEDO
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State | FL
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Zip | 32765-4402
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Country | US
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Telephone | 407-694-8354
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Fax |
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Provider Business Mailing Address
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Address Line | 258 LAKE BREEZE
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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 | 407-322-7035
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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 | AL 356
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License Number State | FL
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