Provider Demographics
NPI:1780818658
Name:GREGORY, PAMELYN SUZANNE (MPT)
Entity Type:Individual
Prefix:MS
First Name:PAMELYN
Middle Name:SUZANNE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:772 FOXCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1838
Mailing Address - Country:US
Mailing Address - Phone:304-262-8161
Mailing Address - Fax:304-262-6061
Practice Address - Street 1:505 LOST RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-0813
Practice Address - Country:US
Practice Address - Phone:304-268-4670
Practice Address - Fax:304-262-6061
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist