Provider Demographics
NPI:1568646396
Name:AMADOR, GREGORY CARTER (PT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:CARTER
Last Name:AMADOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 HWY 126
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9626
Mailing Address - Country:US
Mailing Address - Phone:541-902-0231
Mailing Address - Fax:541-902-7805
Practice Address - Street 1:1845 HWY 126
Practice Address - Street 2:SUITE A-1
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9626
Practice Address - Country:US
Practice Address - Phone:541-902-0231
Practice Address - Fax:541-902-7805
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic