Provider Demographics
NPI:1386069086
Name:GRIEGO, KAITLIN ROSE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ROSE
Last Name:GRIEGO
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 W NEW HOPE RD APT A5
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-7587
Mailing Address - Country:US
Mailing Address - Phone:609-290-5115
Mailing Address - Fax:
Practice Address - Street 1:1115 BROOKS ST
Practice Address - Street 2:SEYMOUR JOHNSON AIR FORCE BASE
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27531
Practice Address - Country:US
Practice Address - Phone:919-722-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer