Provider Demographics
NPI:1881633394
Name:LOMBARD, GREGORY AARON (PTA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:AARON
Last Name:LOMBARD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 BELLMAWR DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-889-2358
Mailing Address - Fax:
Practice Address - Street 1:1854 STONE ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615
Practice Address - Country:US
Practice Address - Phone:585-581-0300
Practice Address - Fax:585-581-0365
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0047991225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant