Individual
MR. GREGORY W SOUTHWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LATC MED
Contact information
Practice address
240 SYKES ST, PALMER, MA 01069-1225
(413) 283-9701
Mailing address
240 SYKES ST, PALMER, MA 01069-1225
(413) 283-9701
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
115
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2255A2300X
—
MA
Enumeration date
10/03/2012
Last updated
10/03/2012
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