Provider Demographics
NPI:1255029823
Name:HOMOL, GREGORY M (ATC LAT CSCS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:M
Last Name:HOMOL
Suffix:
Gender:M
Credentials:ATC LAT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-5702
Mailing Address - Country:US
Mailing Address - Phone:508-612-7375
Mailing Address - Fax:
Practice Address - Street 1:285 OLD WESTPORT RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2356
Practice Address - Country:US
Practice Address - Phone:508-910-6417
Practice Address - Fax:508-999-8867
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAATL35412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer