Provider Demographics
NPI:1871826446
Name:GRAVLEY, TOMMY LEE
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:LEE
Last Name:GRAVLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7569
Mailing Address - Country:US
Mailing Address - Phone:972-318-3744
Mailing Address - Fax:469-533-9883
Practice Address - Street 1:604 ARBOR CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7569
Practice Address - Country:US
Practice Address - Phone:972-318-3744
Practice Address - Fax:469-533-9883
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications