MEDICARE: MRS. ALYSON GRAMLEY 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	703	AL

General Provider Information

NPI Number	:	1891906129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALYSON GRAMLEY ATC

Provider Business Mailing Address
First Line	:	117 MARTHA GEORGE HALL DR
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36081-2452
Country	:	US
Telephone Number	:	334-672-5351
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 STADIUM TOWER
Second Line	:	TROY UNIVERSITY ATHLETIC TRAINING
City	:	TROY
State	:	AL
Zip	:	36082-0001
Country	:	US
Telephone Number	:	334-670-5730
Fax Number	:	334-670-3870

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	08/01/2014

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