Provider Demographics
NPI:1760515191
Name:GREGORY, SASHA L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SASHA
Middle Name:L
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:SASHA
Other - Middle Name:L
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2104 N BROADWAY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2501
Mailing Address - Country:US
Mailing Address - Phone:918-649-0799
Mailing Address - Fax:918-649-0797
Practice Address - Street 1:2244 E SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1443
Practice Address - Country:US
Practice Address - Phone:918-684-9999
Practice Address - Fax:888-663-4223
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1382225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant