Provider Demographics
NPI:1477711166
Name:GREGG, DEBORAH LEE (PTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:GREGG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13690US HWY 441
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-751-3781
Mailing Address - Fax:
Practice Address - Street 1:13690 N US HIGHWAY 441
Practice Address - Street 2:SUITE400
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6810
Practice Address - Country:US
Practice Address - Phone:352-751-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21233225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant