Jason Grotts
Specialist/Technologist, Athletic Trainer in Pana, IL. Individual provider (NPI-1).
NPI number1982139010
StatusActive
Last updated in NPPESJul 30, 2019
Details
- NPI
- 1982139010
- Entity type
- Individual (NPI-1)
- Name
- Jason Grotts
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 26, 2017
- Last updated
- Jul 30, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
107 Wells StPana, IL 62557-1361
Phone 217-565-9530
Mailing address
107 Wells StPana, IL 62557-1361
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