Individual
MR. THEDDY TRECE GERONIMO GRUMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5555 N FRESNO ST, FRESNO, CA 93710-6006
(559) 430-8211
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
50168
CA
Other
Enumeration date
03/19/2020
Last updated
03/19/2020
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