Provider Demographics
NPI:1124085683
Name:GRUBER, RONALD ROSS (ATC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ROSS
Last Name:GRUBER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 DOE RUN RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8711
Mailing Address - Country:US
Mailing Address - Phone:606-783-1629
Mailing Address - Fax:
Practice Address - Street 1:499 VIKING DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-8320
Practice Address - Country:US
Practice Address - Phone:606-784-8956
Practice Address - Fax:606-784-1067
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT3742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer