Provider Demographics
NPI:1710002134
Name:GREINER, GREGORY TED (PT ASST)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:TED
Last Name:GREINER
Suffix:
Gender:M
Credentials:PT ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:510 E NAPLES ST
Mailing Address - Street 2:RM. 28
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2519
Mailing Address - Country:US
Mailing Address - Phone:619-482-6083
Mailing Address - Fax:619-482-8284
Practice Address - Street 1:510 E NAPLES ST
Practice Address - Street 2:RM. 28
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2519
Practice Address - Country:US
Practice Address - Phone:619-482-6083
Practice Address - Fax:619-482-8284
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4882225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant