Provider Demographics
NPI:1578822714
Name:HARRIS, GREGG A (MPT)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5963 KENTSHIRE DRIVE
Mailing Address - Street 2:STE B
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4253
Mailing Address - Country:US
Mailing Address - Phone:937-813-8052
Mailing Address - Fax:937-813-8056
Practice Address - Street 1:463 OHIO PIKE
Practice Address - Street 2:SUITE 203
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3721
Practice Address - Country:US
Practice Address - Phone:513-247-4340
Practice Address - Fax:513-247-4360
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHPT-010752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist