Provider Demographics
NPI:1912636408
Name:AGUILAR, GREGORIO JR
Entity Type:Individual
Prefix:
First Name:GREGORIO
Middle Name:
Last Name:AGUILAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W189N4998 CREST VIEW TER
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6414
Mailing Address - Country:US
Mailing Address - Phone:773-230-1641
Mailing Address - Fax:
Practice Address - Street 1:1810 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5616
Practice Address - Country:US
Practice Address - Phone:262-548-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3263-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant