Provider Demographics
NPI:1083682470
Name:EBERLE, GREGORY DENNIS (ATC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:DENNIS
Last Name:EBERLE
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 1:7501 N UNIVERSITY ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1222
Mailing Address - Country:US
Mailing Address - Phone:309-693-0818
Mailing Address - Fax:309-693-0827
Practice Address - Street 1:7501 N UNIVERSITY ST
Practice Address - Street 2:SUITE 121
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1222
Practice Address - Country:US
Practice Address - Phone:309-693-0818
Practice Address - Fax:309-693-0827
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer