Healthcare Provider Details

I. General information

NPI: 1063933174
Provider Name (Legal Business Name): GRANT ABBUHL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 WILLOW PASS RD STE 110
CONCORD CA
94520-5225
US

IV. Provider business mailing address

1719 MARY DR
PLEASANT HILL CA
94523-2234
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-7431
  • Fax: 925-676-1256
Mailing address:
  • Phone: 510-282-0774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number11016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: