Provider Demographics
NPI:1881068013
Name:HALBART, GREGORY MARC (PT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MARC
Last Name:HALBART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 US HIGHWAY 17
Mailing Address - Street 2:SUITE2A
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3796
Mailing Address - Country:US
Mailing Address - Phone:912-756-5699
Mailing Address - Fax:912-756-5388
Practice Address - Street 1:2709 US HIGHWAY 17
Practice Address - Street 2:SUITE2A
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3796
Practice Address - Country:US
Practice Address - Phone:912-756-5699
Practice Address - Fax:912-756-5388
Is Sole Proprietor?:No
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist