Individual
KELLY GRAYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 E WASHINGTON CENTER RD, FORT WAYNE, IN 46825-4556
(260) 496-4700
Mailing address
1935 BEAR PAW DR, FORT WAYNE, IN 46815-7925
(260) 271-3693
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/21/2019
Last updated
11/21/2019
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