Provider Demographics
NPI:1114080322
Name:RYBICKI, GREGORY EDMUND (PT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:EDMUND
Last Name:RYBICKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 LANCASTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1600
Mailing Address - Country:US
Mailing Address - Phone:302-995-6095
Mailing Address - Fax:302-995-6096
Practice Address - Street 1:3604 LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1600
Practice Address - Country:US
Practice Address - Phone:302-995-6095
Practice Address - Fax:302-995-6096
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000032905Medicaid
8190323OtherAETNA
DE1000032543Medicaid
DE1000032543Medicaid