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NPI Code Detail

MEDICARE: TRAVIS GRONDEL PTA

MEDICARE: TRAVIS GRONDEL PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantA-0832NV

General Provider Information

NPI Number : 1003277484
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS GRONDEL PTA
Provider Business Mailing Address
First Line : 3213 FENCE RIDER AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-5111
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3831 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1859
Country : US
Telephone Number : 702-876-1733
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2016
Last Update Date : 03/14/2016

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Directions to “ TRAVIS GRONDEL PTA” Practice Location

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