Provider Demographics
NPI:1790748945
Name:BEHRENS, GREGORY C (ATC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:C
Last Name:BEHRENS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WESTROCK FARM DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45322-8760
Mailing Address - Country:US
Mailing Address - Phone:937-836-2331
Mailing Address - Fax:
Practice Address - Street 1:4916 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OH
Practice Address - Zip Code:45315-9714
Practice Address - Country:US
Practice Address - Phone:937-832-6048
Practice Address - Fax:937-832-6037
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer