Individual
RYAN GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
5838 SIX FORKS RD, SUITE 300, RALEIGH, NC 27609-3885
(919) 782-5954
Mailing address
4318 SIDES ST, WINSTON SALEM, NC 27103-5947
(336) 480-5045
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
LAT-2943
NC
Other
Enumeration date
10/14/2016
Last updated
10/14/2016
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