Provider Demographics
NPI:1285179192
Name:GREGORICH, JOHN MATHEW JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MATHEW
Last Name:GREGORICH
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:11118 GRANDE PINES CIR APT 213
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-9310
Mailing Address - Country:US
Mailing Address - Phone:440-669-3968
Mailing Address - Fax:
Practice Address - Street 1:13838 OSPREY NEST LN
Practice Address - Street 2:APT 270
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6169
Practice Address - Country:US
Practice Address - Phone:440-669-3968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-01
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0043502255A2300X
TN18112255A2300X
NY0029032255A2300X
TXAT74062255A2300X
FLAL37962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer