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General NPI Number Information
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NPI Number | 1598698474
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Entity Type | Individual
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Provider Name | TRAVIS JARED GRANGRUTH BS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 5155 55TH ST NW
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City | ROCHESTER
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State | MN
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Zip | 55901-3855
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Country | US
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Telephone | 507-535-1977
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Fax |
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Provider Business Mailing Address
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Address Line | 615 W 5TH ST
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City | ZUMBROTA
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State | MN
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Zip | 55992-1157
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Country | US
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Telephone | 612-964-5524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 3694
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License Number State | MN
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