Provider Demographics
NPI:1033185012
Name:GAITHER, GREGORY TODD (MS, AT,C, LAT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:TODD
Last Name:GAITHER
Suffix:
Gender:M
Credentials:MS, AT,C, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3558 WALDORF DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3826
Mailing Address - Country:US
Mailing Address - Phone:214-358-0352
Mailing Address - Fax:
Practice Address - Street 1:1 COWBOYS PKWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4924
Practice Address - Country:US
Practice Address - Phone:972-556-9341
Practice Address - Fax:972-556-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0498024472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer