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Individual

GREGORY CLARK DOROW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
4400 INTERLAKE AVE N, SEATTLE, WA 98103-7519
(763) 237-4228
Mailing address
4455 INTERLAKE AVE N UNIT 133, SEATTLE, WA 98103-7570
(763) 237-4228

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
60989159
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3059
MN ATC LICENSE
MN
01
60989159
WA ATHLETIC TRAINER LICENSE
WA
Enumeration date
09/09/2021
Last updated
09/09/2021
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