Provider Demographics
NPI:1013462464
Name:GRITZ, TRENT (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:GRITZ
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 W COAL AVE
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1717
Mailing Address - Country:US
Mailing Address - Phone:405-609-4070
Mailing Address - Fax:
Practice Address - Street 1:908 W COAL AVE
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1717
Practice Address - Country:US
Practice Address - Phone:405-609-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4322255A2300X
TXAT41452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer