Healthcare Provider Details

I. General information

NPI: 1003997792
Provider Name (Legal Business Name): GREGORY ALAN HOUTZ ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 SMITHBRIDGE RD GARNET VALLEY HIGH SCHOOL
GLEN MILLS PA
19342-1558
US

IV. Provider business mailing address

128 STONEBRIDGE LN
DOWNINGTOWN PA
19335-5507
US

V. Phone/Fax

Practice location:
  • Phone: 610-579-7757
  • Fax:
Mailing address:
  • Phone: 610-269-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT000780A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: