Provider Demographics
NPI:1770565558
Name:NEWELL, GREGORY MATTHEW (MSPT, DPT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MATTHEW
Last Name:NEWELL
Suffix:
Gender:M
Credentials:MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 RAMSEY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5808
Mailing Address - Country:US
Mailing Address - Phone:541-476-1919
Mailing Address - Fax:541-476-1920
Practice Address - Street 1:625 RAMSEY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5808
Practice Address - Country:US
Practice Address - Phone:541-476-1919
Practice Address - Fax:541-476-1920
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR081009-022OtherBLUECROSS BLUESHIELD
ORP00620265OtherMEDICARE RAILROAD
OR182506Medicaid
ORR136842Medicare PIN