Provider Demographics
NPI:1649635905
Name:BEAN, GREGORY DAVID (MS, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DAVID
Last Name:BEAN
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2100
Mailing Address - Country:US
Mailing Address - Phone:716-270-2865
Mailing Address - Fax:716-270-2827
Practice Address - Street 1:4041 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2100
Practice Address - Country:US
Practice Address - Phone:716-270-2865
Practice Address - Fax:716-270-2827
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0006562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer