Provider Demographics
NPI:1396736914
Name:GREGORY, RYAN PATRICK (PT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:GREGORY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MALLORY LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8233
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:805 BLANKENBAKER PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1894
Practice Address - Country:US
Practice Address - Phone:502-253-0833
Practice Address - Fax:502-253-0834
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT7171225100000X
KY5784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3659508Medicaid
TN3659508Medicare PIN
TN3659508Medicaid