Provider Demographics
NPI:1417619479
Name:GRATHWOHL, TAYLOR ANGELA
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANGELA
Last Name:GRATHWOHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LAKESIDE CV
Mailing Address - Street 2:
Mailing Address - City:MARTINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:78655-3968
Mailing Address - Country:US
Mailing Address - Phone:210-363-9016
Mailing Address - Fax:
Practice Address - Street 1:202 LAKESIDE CV
Practice Address - Street 2:
Practice Address - City:MARTINDALE
Practice Address - State:TX
Practice Address - Zip Code:78655-3968
Practice Address - Country:US
Practice Address - Phone:210-363-9016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program