Provider Demographics
NPI:1831638345
Name:TALBOT, GREGORY (PT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:TALBOT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BEVERLY ST APT 536
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2295
Mailing Address - Country:US
Mailing Address - Phone:607-661-3699
Mailing Address - Fax:
Practice Address - Street 1:110 BEVERLY ST APT 536
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2295
Practice Address - Country:US
Practice Address - Phone:607-661-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist