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1104452267
THEDDY TRECE GERONIMO GRUMO
FRESNO, CA
NPI
1104452267
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: CA 50168)
Enumeration Date
2020-03-19
Last Update Date
2020-03-19
Business Address
Mr. THEDDY TRECE GERONIMO GRUMO PTA
5555 N FRESNO ST
FRESNO, CA 93710-6006
Phone number: 559-430-8211
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Mailing Address
Mr. THEDDY TRECE GERONIMO GRUMO PTA
4560 SE INTERNATIONAL WAY STE 100
MILWAUKIE, OR 97222-4628
Phone number:
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