Healthcare Provider Details

I. General information

NPI: 1366328957
Provider Name (Legal Business Name): HALLE GREGORICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 NEW PINERY RD
PORTAGE WI
53901-9257
US

IV. Provider business mailing address

2815 NEW PINERY RD
PORTAGE WI
53901-9257
US

V. Phone/Fax

Practice location:
  • Phone: 608-745-6290
  • Fax: 608-745-6250
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17452-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: