Provider Demographics
NPI:1083711238
Name:GREGORY, VIRGINIA PERRY (PT)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:PERRY
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:V.
Other - Middle Name:MARIE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1742 DEER LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1218
Mailing Address - Country:US
Mailing Address - Phone:615-829-0212
Mailing Address - Fax:
Practice Address - Street 1:1742 DEER LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1218
Practice Address - Country:US
Practice Address - Phone:615-829-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT7660225100000X
KY005783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3646784Medicaid
TN3646784Medicare PIN