Provider Demographics
NPI:1619642956
Name:GRIER, JOHN ADAM (ATC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ADAM
Last Name:GRIER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19117 FERN MEADOW LOOP
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4003
Mailing Address - Country:US
Mailing Address - Phone:404-401-9786
Mailing Address - Fax:
Practice Address - Street 1:19117 FERN MEADOW LOOP
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4003
Practice Address - Country:US
Practice Address - Phone:404-401-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL63802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer