Jill Ann Grant, ATC
Individual provider Active NPI Athletic Trainer · Woodstock Valley, CT
NPI 1508419946 · NPPES record last updated Jul 23, 2019
Key facts
- NPI
- 1508419946
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 75 Brockway Rd
Woodstock Valley, CT 06282-2703 - Phone
- (860) 974-1174
- NPI assigned
- Jul 23, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
75 Brockway Rd
Woodstock Valley, CT 06282-2703
Mailing address
75 Brockway Rd
Woodstock Valley, CT 06282-2703
Phone (860) 974-1174
Other providers in Woodstock Valley, CT
All providers in Woodstock Valley, CT · Athletic Trainer in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.