Provider Demographics
NPI:1740006188
Name:GREGERSEN PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:GREGERSEN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:314-283-4459
Mailing Address - Street 1:1025 W FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4139
Mailing Address - Country:US
Mailing Address - Phone:314-283-4459
Mailing Address - Fax:
Practice Address - Street 1:4927 N LYDELL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5849
Practice Address - Country:US
Practice Address - Phone:314-283-4459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy