Provider Demographics
NPI:1255186391
Name:HINMAN, GREGORY THOMAS (225400000X)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:THOMAS
Last Name:HINMAN
Suffix:
Gender:M
Credentials:225400000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 EUCALYPTUS KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2200
Mailing Address - Country:US
Mailing Address - Phone:650-464-4575
Mailing Address - Fax:
Practice Address - Street 1:201 ALAMEDA DEL PRADO STE 201
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6698
Practice Address - Country:US
Practice Address - Phone:415-526-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner