Healthcare Provider Details

I. General information

NPI: 1083787915
Provider Name (Legal Business Name): DANIELLE GREGOIRE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 ROOSEVELT BLVD
PHILADELPHIA PA
19114-2212
US

IV. Provider business mailing address

1812 MARSH RD STE 505
WILMINGTON DE
19810-4515
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-6200
  • Fax: 215-464-9834
Mailing address:
  • Phone: 302-793-0432
  • Fax: 302-793-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018268
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: