Provider Demographics
NPI:1407095086
Name:GREGG, JODY LYNN (CMMT)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:LYNN
Last Name:GREGG
Suffix:
Gender:F
Credentials:CMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 W NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4750
Mailing Address - Country:US
Mailing Address - Phone:616-890-7294
Mailing Address - Fax:
Practice Address - Street 1:765 W NORTON AVE
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4750
Practice Address - Country:US
Practice Address - Phone:616-890-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172M00000X, 225700000X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation