Healthcare Provider Details

I. General information

NPI: 1013100999
Provider Name (Legal Business Name): ANDREW EUGENE GROMEK PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDY GROMEK PTA

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17270 RED OAK DR 100
HOUSTON TX
77090-2618
US

IV. Provider business mailing address

17270 RED OAK DR 200
HOUSTON TX
77090-2618
US

V. Phone/Fax

Practice location:
  • Phone: 281-880-1454
  • Fax: 281-880-1572
Mailing address:
  • Phone: 281-880-1454
  • Fax: 281-880-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2037901
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: