Provider Demographics
NPI:1407218373
Name:COLVIN, GREGORY (PT, DPT, MS, ATC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:COLVIN
Suffix:
Gender:M
Credentials:PT, DPT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1864
Mailing Address - Country:US
Mailing Address - Phone:484-526-7676
Mailing Address - Fax:
Practice Address - Street 1:1441 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1864
Practice Address - Country:US
Practice Address - Phone:484-526-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist