Provider Demographics
NPI:1093859068
Name:PENDLEY, GREG A (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:A
Last Name:PENDLEY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 WHITE WAY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3126
Mailing Address - Country:US
Mailing Address - Phone:205-822-8860
Mailing Address - Fax:
Practice Address - Street 1:1901 LAKESHORE DR S
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-6730
Practice Address - Country:US
Practice Address - Phone:205-871-9663
Practice Address - Fax:205-879-0879
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer