Provider Demographics
NPI:1679237200
Name:GREGORY, STEVEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:GREGORY
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 1:9475B COUNTY ROAD 13 N
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2606
Mailing Address - Country:US
Mailing Address - Phone:904-347-1293
Mailing Address - Fax:
Practice Address - Street 1:120 CYPRESS EDGE DR STE 101
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8454
Practice Address - Country:US
Practice Address - Phone:386-586-1691
Practice Address - Fax:386-586-1691
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic