MEDICARE: DEBORAH LEE GREGG PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA21233	FL

General Provider Information

NPI Number	:	1477711166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH LEE GREGG PTA

Provider Business Mailing Address
First Line	:	13690US HWY 441
Second Line	:	SUITE 400
City	:	LADY LAKE
State	:	FL
Zip	:	32159
Country	:	US
Telephone Number	:	352-751-3781
Fax Number	:

Provider Business Practice Location Address
First Line	:	13690 N US HIGHWAY 441
Second Line	:	SUITE400
City	:	LADY LAKE
State	:	FL
Zip	:	32159-6810
Country	:	US
Telephone Number	:	352-751-3781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	01/08/2014

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