Provider Demographics
NPI:1023366879
Name:NORDLUND, GREGORY BRIAN (MA, ATC/L, PES)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:BRIAN
Last Name:NORDLUND
Suffix:
Gender:M
Credentials:MA, ATC/L, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 WILLIAMSBURG CT.
Mailing Address - Street 2:UNIT D
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189
Mailing Address - Country:US
Mailing Address - Phone:630-215-8885
Mailing Address - Fax:
Practice Address - Street 1:5530 S ELLIS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1402
Practice Address - Country:US
Practice Address - Phone:773-702-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960031222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer