MEDICARE: MR. RORY A GRADY JR. ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	002317	NY

General Provider Information

NPI Number	:	1134576945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RORY A GRADY JR. ATC

Provider Business Mailing Address
First Line	:	22575 LEANNE TER APT 444
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20148-6858
Country	:	US
Telephone Number	:	516-423-1962
Fax Number	:	703-237-1465

Provider Business Practice Location Address
First Line	:	6600 LITTLE FALLS RD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22213-1211
Country	:	US
Telephone Number	:	703-237-1456
Fax Number	:	703-237-1465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2016
Last Update Date	:	01/13/2021

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