Provider Demographics
NPI:1073682704
Name:FRITZ, GREGORY EUGENE (PT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:EUGENE
Last Name:FRITZ
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 1:3001 R AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4602
Mailing Address - Country:US
Mailing Address - Phone:360-299-2781
Mailing Address - Fax:360-299-3038
Practice Address - Street 1:3001 R AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4602
Practice Address - Country:US
Practice Address - Phone:360-299-2781
Practice Address - Fax:360-299-3038
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA126555OtherDEPT OF LABOR & INDUSTRIE
WA8356768Medicaid
WAG8853635Medicare PIN