Provider Demographics
NPI:1861278996
Name:AGRUDA, JON (PT, DPT)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:AGRUDA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:AGRUDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8614 ROSE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5342
Mailing Address - Country:US
Mailing Address - Phone:832-277-6203
Mailing Address - Fax:
Practice Address - Street 1:14857 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5016
Practice Address - Country:US
Practice Address - Phone:281-242-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1379211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist