Provider Demographics
NPI:1649932930
Name:GRATEROL MALDONADO, RUBY GABRIELA
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:GABRIELA
Last Name:GRATEROL MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 SOUTHFORK DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7267
Mailing Address - Country:US
Mailing Address - Phone:513-293-8901
Mailing Address - Fax:
Practice Address - Street 1:286 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1236
Practice Address - Country:US
Practice Address - Phone:513-539-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist