Grant Wilson III, MS, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

140 Patrick Gym 97 Spear St
Burlington, VT 05405-0001

Phone

(802) 656-9951

NPI assigned

Jun 8, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467493031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801",
            "city": "RICHMOND",
            "state": "VT",
            "postal_code": "054770801",
            "telephone_number": "802-310-1790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 PATRICK GYM 97 SPEAR ST",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054050001",
            "telephone_number": "802-656-9951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "GRANT",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MS, ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Willis, M.A.
• Lewis Willmuth, M.D.
• Mary Willmuth, PH.D.
• Noah Willows, MD
• Diana Wilson, MD
• Jacqueline L Wilson
• Jerry Paul Wilson Jr., RN
• Jenna Gale Winebaum, MD
• Audrey Beth Winograd, MSW
• Barbara Winters, COTA

• Athletic Trainer in Burlington, VT
• Providers in Burlington, VT by specialty
• Athletic Trainer in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.