Provider Demographics
NPI:1134775612
Name:GRIGGS, STEPHEN LOUIS (ATC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:LOUIS
Last Name:GRIGGS
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 1:258 LAKEBREEZE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6042
Mailing Address - Country:US
Mailing Address - Phone:407-221-3462
Mailing Address - Fax:
Practice Address - Street 1:1560 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5540
Practice Address - Country:US
Practice Address - Phone:407-221-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer