Provider Demographics
NPI:1780818872
Name:GREGORY, MALCOLM ERNEST (DPT, PHD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:ERNEST
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DPT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1420
Mailing Address - Country:US
Mailing Address - Phone:412-833-8218
Mailing Address - Fax:
Practice Address - Street 1:3448 FOREST RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1420
Practice Address - Country:US
Practice Address - Phone:412-833-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist