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General NPI Number Information
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NPI Number | 1972532455
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Entity Type | Individual
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Provider Name | ROBERT SIMPSON GRAY JR. ATC
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30033 CLEMENS RD
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City | WESTLAKE
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State | OH
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Zip | 44145-1021
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Country | US
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Telephone | 440-899-5645
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Fax | 440-899-3160
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Provider Business Mailing Address
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Address Line | 126 PEPPERDINE DR
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City | ELYRIA
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State | OH
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Zip | 44035-1566
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Country | US
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Telephone | 440-366-9429
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Fax | 440-899-3160
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT000284
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License Number State | OH
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