Provider Demographics
NPI:1346589835
Name:GAMERO, JUAN JESUS (PTA)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JESUS
Last Name:GAMERO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1617
Mailing Address - Country:US
Mailing Address - Phone:440-237-2558
Mailing Address - Fax:
Practice Address - Street 1:50 KINGS CT
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1617
Practice Address - Country:US
Practice Address - Phone:330-697-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2461225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant