Provider Demographics
NPI:1386899367
Name:GERONA, RAMON MEDINA JR (PT)
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:MEDINA
Last Name:GERONA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:RAMON JR
Other - Middle Name:MEDINA
Other - Last Name:GERONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:9301 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7745
Mailing Address - Country:US
Mailing Address - Phone:219-662-5077
Mailing Address - Fax:
Practice Address - Street 1:9301 MADISON ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7745
Practice Address - Country:US
Practice Address - Phone:219-662-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010134A225100000X
COPTL 0009514225100000X
IA4565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist