Provider Demographics
NPI:1891345336
Name:ROBBINS, GRANT ANTHONY (PTA)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:ANTHONY
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 E FIR AVE APT 240
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2788
Mailing Address - Country:US
Mailing Address - Phone:916-342-4370
Mailing Address - Fax:
Practice Address - Street 1:7265 N 1ST ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2956
Practice Address - Country:US
Practice Address - Phone:559-431-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA48809225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant