Healthcare Provider Details

I. General information

NPI: 1134222367
Provider Name (Legal Business Name): TINA GAIL GREGORY RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 WOODSIDE DR
AMARILLO TX
79124-1028
US

IV. Provider business mailing address

2213 WOODSIDE DR
AMARILLO TX
79124-1028
US

V. Phone/Fax

Practice location:
  • Phone: 806-468-8525
  • Fax:
Mailing address:
  • Phone: 806-468-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number63289
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30001203A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: