Provider Demographics
NPI:1053082248
Name:GRUBB, KENNETH EUGENE (LMT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EUGENE
Last Name:GRUBB
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BRANDON WAY
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-8500
Mailing Address - Country:US
Mailing Address - Phone:859-499-1009
Mailing Address - Fax:859-499-1016
Practice Address - Street 1:107 BRANDON WAY
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-8500
Practice Address - Country:US
Practice Address - Phone:859-499-1009
Practice Address - Fax:859-499-1016
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty