Provider Demographics
NPI:1669234423
Name:POLICARI, GREGG (LMBT)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:POLICARI
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 OLEANDER DR STE 102A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3577
Mailing Address - Country:US
Mailing Address - Phone:910-313-1322
Mailing Address - Fax:910-313-1323
Practice Address - Street 1:6303 OLEANDER DR STE 102A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3577
Practice Address - Country:US
Practice Address - Phone:910-313-1322
Practice Address - Fax:910-313-1323
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4596225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist