Provider Demographics
NPI:1164632618
Name:GRACE, JAROD SCOTT (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAROD
Middle Name:SCOTT
Last Name:GRACE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:651 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36849-5322
Mailing Address - Country:US
Mailing Address - Phone:334-844-9829
Mailing Address - Fax:334-844-0295
Practice Address - Street 1:651 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-5322
Practice Address - Country:US
Practice Address - Phone:334-844-9829
Practice Address - Fax:334-844-0295
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer