Most Relevant Information
Provider Data
| NPI Number: | 1003277484 |
| Provider Name: | TRAVIS GRONDEL PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | A-0832 |
Most Important Dates
| Enumeration Date: | 03/14/2016 |
| Last Updated: | 03/14/2016 |
Provider Practice Location
3831 W CHARLESTON BLVD
LAS VEGAS
NV
891021859
Practice Location Phone/Fax
| Phone: | 7028761733 |
| Fax: |
Provider Mailing Location
3213 FENCE RIDER AVE
NORTH LAS VEGAS
NV
890315111
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |