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General NPI Number Information
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NPI Number | 1982129391
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Entity Type | Individual
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Provider Name | LONNIE GROSS JR. ATC
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Gender | Male
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 325 STRANGER ST
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City | BLACKSBURG
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State | VA
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Zip | 24061-0001
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Country | US
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Telephone | 540-815-4336
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Fax |
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Provider Business Mailing Address
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Address Line | 402 VINCENT ST NW
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City | ROANOKE
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State | VA
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Zip | 24012-1522
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Country | US
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Telephone | 540-815-4336
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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 |
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License Number State |
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