Provider Demographics
NPI:1417080128
Name:GREGORY, RICHARD LEO (MS PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEO
Last Name:GREGORY
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:425-488-6463
Mailing Address - Fax:425-488-0382
Practice Address - Street 1:12437 NE 173RD PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:425-488-6463
Practice Address - Fax:425-488-0382
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGR2567OtherREGENCE
WA63048OtherLC
WA7036585Medicaid
WAGR2567OtherREGENCE