Provider Demographics
NPI:1609435460
Name:AMAYA, GREGORY MANUEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MANUEL
Last Name:AMAYA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 TAMARUS ST APT 244
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5712
Mailing Address - Country:US
Mailing Address - Phone:760-238-1860
Mailing Address - Fax:
Practice Address - Street 1:1550 W CRAIG RD STE 210
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0327
Practice Address - Country:US
Practice Address - Phone:702-360-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist