Individual
MR. GRANT WILSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT
Contact information
Practice address
140 PATRICK GYM 97 SPEAR ST, BURLINGTON, VT 05405-0001
(802) 656-9951
Mailing address
PO BOX 801, RICHMOND, VT 05477-0801
(802) 310-1790
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
VT
Other
Enumeration date
06/08/2006
Last updated
07/08/2007
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