Provider Demographics
NPI:1083787915
Name:GREGOIRE, DANIELLE (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 MARSH RD STE 505
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4515
Mailing Address - Country:US
Mailing Address - Phone:302-793-0432
Mailing Address - Fax:302-793-0400
Practice Address - Street 1:9475 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2212
Practice Address - Country:US
Practice Address - Phone:215-464-6200
Practice Address - Fax:215-464-9834
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083787915OtherCHAMPUS TRICARE
PA223531OtherPABS
2849800000OtherAMERIHEALTH IBC
1083787915OtherCHAMPUS TRICARE