Provider Demographics
NPI:1841587300
Name:GRAESSLE, MATTHEW ROBERT (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:GRAESSLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 N BEND RD STE C
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-2502
Mailing Address - Country:US
Mailing Address - Phone:859-267-2293
Mailing Address - Fax:859-287-3291
Practice Address - Street 1:3065 N BEND RD STE C
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-2502
Practice Address - Country:US
Practice Address - Phone:859-267-2293
Practice Address - Fax:859-287-3291
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013179225100000X
IN05010472A225100000X
KY008199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist