Provider Demographics
NPI:1649679788
Name:GRIESEMER, BRETT (MAED, ATC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:GRIESEMER
Suffix:
Gender:M
Credentials:MAED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 STADIUM RD
Mailing Address - Street 2:160 JAMERSON ATHLETIC CENTER
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24061-1024
Mailing Address - Country:US
Mailing Address - Phone:540-641-3536
Mailing Address - Fax:
Practice Address - Street 1:510 STADIUM RD
Practice Address - Street 2:160 JAMERSON ATHLETIC CENTER
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-1024
Practice Address - Country:US
Practice Address - Phone:540-641-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260018502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0126001850OtherATHLETIC TRAINING STATE LICENSURE
VA2000003223OtherATHLETIC TRAINING BOARD OF CERTIFICATION