Provider Demographics
NPI:1861671273
Name:JANCAITIS, GREGORY (MED, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:JANCAITIS
Suffix:
Gender:M
Credentials:MED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SACO RD
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-6240
Mailing Address - Country:US
Mailing Address - Phone:207-642-9080
Mailing Address - Fax:207-929-9147
Practice Address - Street 1:700 SACO RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6240
Practice Address - Country:US
Practice Address - Phone:207-642-5325
Practice Address - Fax:207-929-9147
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT3002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer