Provider Demographics
NPI:1801480843
Name:GRECO, PAXTON JOANN
Entity type:Individual
Prefix:
First Name:PAXTON
Middle Name:JOANN
Last Name:GRECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 HOWARD STREET, EVANSVILLE, IN, USA
Mailing Address - Street 2:C14
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713
Mailing Address - Country:US
Mailing Address - Phone:217-299-5388
Mailing Address - Fax:
Practice Address - Street 1:1407 HOWARD STREET, EVANSVILLE, IN, USA
Practice Address - Street 2:C14
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713
Practice Address - Country:US
Practice Address - Phone:217-299-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36003399A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer