Provider Demographics
NPI:1306832548
Name:HELGATH, GREGORY J (PT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:HELGATH
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 1:210 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1411
Mailing Address - Country:US
Mailing Address - Phone:360-354-3030
Mailing Address - Fax:360-354-1013
Practice Address - Street 1:210 THIRD ST
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1411
Practice Address - Country:US
Practice Address - Phone:360-354-3030
Practice Address - Fax:360-354-1013
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7059199Medicaid
WAGAB09344Medicare PIN
WAR12222Medicare UPIN