Ronald Gray, LPTA

Individual provider Active NPI Physical Therapy Assistant · Alturas, CA

NPI 1104371285 · NPPES record last updated Aug 18, 2016

Key facts

NPI
1104371285
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
AT5744 (CA)
Practice address
120 S Main St
Alturas, CA 96101-4084
Phone
(530) 233-7055
Fax
(530) 233-4513
NPI assigned
Aug 18, 2016
Sex
Male
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
AT5744CAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Last Frontier Healthcare District Past Accepting new patients
Last Frontier Healthcare District Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X AT5744 CA Yes

Addresses

Primary practice location

120 S Main St
Alturas, CA 96101-4084

Mailing address

120 S Main St
Alturas, CA 96101-4084
Phone (530) 233-7055

Other providers in Alturas, CA

All providers in Alturas, CA · Physical Therapy Assistant in California

Sources for this page

Verify at the official NPI Registry.