Provider Demographics
NPI:1891752887
Name:EVERTS, GREGG ALLAN (ATC/L)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:ALLAN
Last Name:EVERTS
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 S 110TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2348
Mailing Address - Country:US
Mailing Address - Phone:414-453-1624
Mailing Address - Fax:414-453-1625
Practice Address - Street 1:1105 S 110TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-2348
Practice Address - Country:US
Practice Address - Phone:414-453-1624
Practice Address - Fax:414-453-1625
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2570392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer