Provider Demographics
NPI:1609212992
Name:JOSEPH, GREGORY (DPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CALVIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3804
Mailing Address - Country:US
Mailing Address - Phone:802-376-5169
Mailing Address - Fax:
Practice Address - Street 1:22 CALVIN ST APT 3
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3804
Practice Address - Country:US
Practice Address - Phone:802-376-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist