Provider Demographics
NPI:1831483478
Name:GREGORIO, GARY GLENN (BSPT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:GLENN
Last Name:GREGORIO
Suffix:
Gender:M
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 VERMEER DR APT 19
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2341
Mailing Address - Country:US
Mailing Address - Phone:732-407-7895
Mailing Address - Fax:
Practice Address - Street 1:3 INDUSTRIAL WAY E
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3318
Practice Address - Country:US
Practice Address - Phone:732-544-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00616800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist