Provider Demographics
NPI:1073507430
Name:NIBBELINK, GREGG STUART (ATC)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:STUART
Last Name:NIBBELINK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 TERESA DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1611
Mailing Address - Country:US
Mailing Address - Phone:443-507-0113
Mailing Address - Fax:
Practice Address - Street 1:2 COLLEGE HL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-4303
Practice Address - Country:US
Practice Address - Phone:410-857-2584
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer