Provider Demographics
NPI:1164973103
Name:GROOM, ARISTA (LAT, ATC, EMT)
Entity Type:Individual
Prefix:MRS
First Name:ARISTA
Middle Name:
Last Name:GROOM
Suffix:
Gender:F
Credentials:LAT, ATC, EMT
Other - Prefix:
Other - First Name:ARISTA
Other - Middle Name:
Other - Last Name:WAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:1407 WHEAT RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-4705
Mailing Address - Country:US
Mailing Address - Phone:620-221-5100
Mailing Address - Fax:
Practice Address - Street 1:300 VIKING BLVD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2508
Practice Address - Country:US
Practice Address - Phone:620-221-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-007772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer