Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Theddy Trece Geronimo Grumo, PTA

Individual provider Physical Therapy Assistant · NPI 1104452267

Mr. Theddy Trece Geronimo Grumo, PTA is a Physical Therapy Assistant in Fresno, California. Licensed in California. Registered with an NPI since 2020.

Licensed in
CA
In the registry since
2020
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

5555 N Fresno St
Fresno, CA 93710-6006
Phone: (559) 430-8211
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 50168 (CA)

Record details

NPI number1104452267
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedMarch 19, 2020
Last updated in NPPESMarch 19, 2020
Certification dateMarch 19, 2020

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