Provider Demographics
NPI:1124077607
Name:GRUBE, RYAN J (PT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:GRUBE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 LINDLE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2428
Mailing Address - Country:US
Mailing Address - Phone:717-803-3342
Mailing Address - Fax:717-974-8743
Practice Address - Street 1:868 N US ROUTE 15
Practice Address - Street 2:
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-1617
Practice Address - Country:US
Practice Address - Phone:717-973-5813
Practice Address - Fax:717-715-1064
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013693L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT013693LMedicare Oscar/Certification