Provider Demographics
NPI:1003947342
Name:TODD, GREGORY A (PT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:TODD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 ASHLEY OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7008
Mailing Address - Country:US
Mailing Address - Phone:813-907-0430
Mailing Address - Fax:813-907-0963
Practice Address - Street 1:2008 ASHLEY OAKS CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-7008
Practice Address - Country:US
Practice Address - Phone:813-907-0430
Practice Address - Fax:813-907-0963
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT19273OtherPHYSICAL THERAPIST