Provider Demographics
NPI:1790750131
Name:GREGORY, GWENDOLYN ELIZABETH (ATC)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:ELIZABETH
Last Name:GREGORY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13450 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1073
Mailing Address - Country:US
Mailing Address - Phone:810-629-5584
Mailing Address - Fax:
Practice Address - Street 1:2345 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2211
Practice Address - Country:US
Practice Address - Phone:810-635-1019
Practice Address - Fax:810-635-1008
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer