Provider Demographics
NPI:1972532455
Name:GRAY, ROBERT SIMPSON JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SIMPSON
Last Name:GRAY
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PEPPERDINE DR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1566
Mailing Address - Country:US
Mailing Address - Phone:440-366-9429
Mailing Address - Fax:440-899-3160
Practice Address - Street 1:30033 CLEMENS RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1021
Practice Address - Country:US
Practice Address - Phone:440-899-5645
Practice Address - Fax:440-899-3160
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0002842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer