Provider Demographics
NPI:1104371285
Name:GRAY, RONALD (LPTA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-4084
Mailing Address - Country:US
Mailing Address - Phone:530-233-7055
Mailing Address - Fax:530-233-4513
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-4084
Practice Address - Country:US
Practice Address - Phone:530-233-7055
Practice Address - Fax:530-233-4513
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT5744225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant