Provider Demographics
NPI:1639621998
Name:GRECO, CHAELI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHAELI
Middle Name:
Last Name:GRECO
Suffix:
Gender:F
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 1:913 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7853
Mailing Address - Country:US
Mailing Address - Phone:402-932-0747
Mailing Address - Fax:402-991-5685
Practice Address - Street 1:913 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7853
Practice Address - Country:US
Practice Address - Phone:402-932-0747
Practice Address - Fax:402-991-5685
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4456225100000X
WI13643 - 24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist