Provider Demographics
NPI:1093013120
Name:PRITCHETT, GREGORY DEAN (MA 60208918)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DEAN
Last Name:PRITCHETT
Suffix:
Gender:M
Credentials:MA 60208918
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9507 N DIVISION ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1555
Mailing Address - Country:US
Mailing Address - Phone:509-675-5571
Mailing Address - Fax:
Practice Address - Street 1:9507 N DIVISION ST STE B
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1555
Practice Address - Country:US
Practice Address - Phone:509-675-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60208918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist