Provider Demographics
NPI:1376699942
Name:GRECO, JAMIE L (PT)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:L
Last Name:GRECO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2442
Mailing Address - Country:US
Mailing Address - Phone:631-862-0376
Mailing Address - Fax:631-862-0376
Practice Address - Street 1:247 3RD ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2442
Practice Address - Country:US
Practice Address - Phone:631-862-0376
Practice Address - Fax:631-862-0376
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0135832251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics