Provider Demographics
NPI:1811783244
Name:GREGORIO, ANITA MARIE
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:GREGORIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 57TH CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-4159
Mailing Address - Country:US
Mailing Address - Phone:360-628-9030
Mailing Address - Fax:
Practice Address - Street 1:832 E MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7153
Practice Address - Country:US
Practice Address - Phone:541-210-9673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27842225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist