Provider Demographics
NPI:1356713465
Name:GREGG, MIRYANA B (MSPT)
Entity type:Individual
Prefix:
First Name:MIRYANA
Middle Name:B
Last Name:GREGG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S COLLEGE AVE
Mailing Address - Street 2:#2
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-4903
Mailing Address - Country:US
Mailing Address - Phone:509-520-3141
Mailing Address - Fax:
Practice Address - Street 1:1100 S COLLEGE AVE
Practice Address - Street 2:#2
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-4903
Practice Address - Country:US
Practice Address - Phone:509-520-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT00008479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist