Provider Demographics
NPI:1033217054
Name:GROSSGLASS, RANDALL WALTER (PT)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:WALTER
Last Name:GROSSGLASS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:3904 BELLEWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-3106
Mailing Address - Country:US
Mailing Address - Phone:813-508-5474
Mailing Address - Fax:813-684-1356
Practice Address - Street 1:134 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8101
Practice Address - Country:US
Practice Address - Phone:813-681-1627
Practice Address - Fax:813-684-1356
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT184792251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic