Provider Demographics
NPI:1639621998
Name:GRECO, CHAELI (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:CHAELI
Middle Name:
Last Name:GRECO
Suffix:
Gender:
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9840 S 168TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1102
Mailing Address - Country:US
Mailing Address - Phone:402-350-4634
Mailing Address - Fax:531-325-9282
Practice Address - Street 1:913 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7853
Practice Address - Country:US
Practice Address - Phone:402-932-0747
Practice Address - Fax:402-991-5685
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4456225100000X
WI13643 - 24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist