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NPI Code Detail

MEDICARE: JAMES M. GRANT MS, ATC, PES

MEDICARE: JAMES M. GRANT MS, ATC, PES
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
12255A2300XAthletic Trainer000141NY

General Provider Information

NPI Number : 1538157052
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES M. GRANT MS, ATC, PES
Provider Business Mailing Address
First Line : 3690 EAST AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14618-3537
Country : US
Telephone Number : 585-385-3744
Fax Number : 585-385-5221
Provider Business Practice Location Address
First Line : 3690 EAST AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14618-3537
Country : US
Telephone Number : 585-385-3744
Fax Number : 585-385-5221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 01/11/2020

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