Provider Demographics
NPI:1295968246
Name:GREGORY, PHILIP LIDE (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:LIDE
Last Name:GREGORY
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E CHEVES ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2716
Mailing Address - Country:US
Mailing Address - Phone:843-777-5043
Mailing Address - Fax:
Practice Address - Street 1:901 E CHEVES ST
Practice Address - Street 2:SUITE 510
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2716
Practice Address - Country:US
Practice Address - Phone:843-777-5043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC59692251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports