Provider Demographics
NPI:1043214943
Name:MORRIS, GREGORY C (PT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:MORRIS
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 1:6000 HEISLEY RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1836
Mailing Address - Country:US
Mailing Address - Phone:440-357-6677
Mailing Address - Fax:440-357-6681
Practice Address - Street 1:6000 HEISLEY RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1836
Practice Address - Country:US
Practice Address - Phone:440-357-6677
Practice Address - Fax:440-357-6681
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT009305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2479894Medicaid
OH2479894Medicaid
OH4130501Medicare PIN