Healthcare Provider Details

I. General information

NPI: 1407095086
Provider Name (Legal Business Name): JODY LYNN GREGG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 3RD AVE
FRUITPORT MI
49415-9774
US

IV. Provider business mailing address

400 N 3RD AVE
FRUITPORT MI
49415-9774
US

V. Phone/Fax

Practice location:
  • Phone: 231-747-9163
  • Fax: 231-247-0700
Mailing address:
  • Phone: 616-890-7294
  • Fax: 231-247-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501000434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: