Provider Demographics
NPI:1326165903
Name:ULANDAY, GREGORY P (ATC,PTA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:P
Last Name:ULANDAY
Suffix:
Gender:M
Credentials:ATC,PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 ATWATER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1908
Mailing Address - Country:US
Mailing Address - Phone:858-722-3775
Mailing Address - Fax:
Practice Address - Street 1:4909 MURPHY CANYON RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4300
Practice Address - Country:US
Practice Address - Phone:619-234-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT3750225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant