Healthcare Provider Details

I. General information

NPI: 1578559209
Provider Name (Legal Business Name): GREGORY P DECATO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BELMONT AVE
YOUNGSTOWN OH
44505-1846
US

IV. Provider business mailing address

PO BOX 66
CANFIELD OH
44406-0066
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-2603
  • Fax: 330-759-2569
Mailing address:
  • Phone: 330-759-2603
  • Fax: 330-759-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: