Individual
GRADY CONGLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18 GOODFRIEND DR, EAST HAMPTON, NY 11937-2584
(631) 907-5000
Mailing address
18 GOODFRIEND DR, EAST HAMPTON, NY 11937-2584
(631) 907-5000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002583
NY
2255A2300X
Athletic Trainer
2451
MA
Other
Enumeration date
10/14/2013
Last updated
10/14/2013
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