Provider Demographics
NPI:1669858148
Name:GRINDLE, MIKAYLA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:GRINDLE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 SW 35TH PL
Mailing Address - Street 2:APT 5H
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3256
Mailing Address - Country:US
Mailing Address - Phone:812-870-6309
Mailing Address - Fax:
Practice Address - Street 1:2323 SW 35TH PL
Practice Address - Street 2:APT 5H
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3256
Practice Address - Country:US
Practice Address - Phone:812-870-6309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL42812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer