Healthcare Provider Details

I. General information

NPI: 1700713450
Provider Name (Legal Business Name): PATRICK GREDING PT, DPT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 POTOMAC WAY
IDAHO FALLS ID
83404-4978
US

IV. Provider business mailing address

1403 W 190 N
PLEASANT GROVE UT
84062-3080
US

V. Phone/Fax

Practice location:
  • Phone: 805-338-8145
  • Fax:
Mailing address:
  • Phone: 805-338-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: