MEDICARE: ASHTIN LEA GRAVLEY LAT, 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

General Provider Information

NPI Number	:	1134992373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHTIN LEA GRAVLEY LAT, ATC

Provider Business Mailing Address
First Line	:	10504 NW 85TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-3697
Country	:	US
Telephone Number	:	816-547-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	2861 NE INDEPENDENCE AVE
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-2350
Country	:	US
Telephone Number	:	816-525-2840
Fax Number	:	816-525-2841

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

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	03/03/2026

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