Provider Demographics
NPI:1669126918
Name:DAVIAU, GREYSON (ATC, EMT)
Entity type:Individual
Prefix:
First Name:GREYSON
Middle Name:
Last Name:DAVIAU
Suffix:
Gender:M
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SMITH MILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:17349-8147
Mailing Address - Country:US
Mailing Address - Phone:717-817-1208
Mailing Address - Fax:
Practice Address - Street 1:441 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3614
Practice Address - Country:US
Practice Address - Phone:717-846-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000053540OtherCERTIFIED ATHLETIC TRAINER
PA1039251OtherPA DEPARTMENT OF HEALTH EMERGENCY MEDICAL TECHNICIAN
PART008255OtherPA STATE BOARD OF MEDICINE