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General NPI Number Information
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NPI Number | 1104860550
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Entity Type | Organization
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Legal Business Name | GREGORY A THWAITES PHD PLLC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 2001 70TH AVE STE 205
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City | GREELEY
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State | CO
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Zip | 80634-4613
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Country | US
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Telephone | 970-392-2190
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Fax | 970-392-2193
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Provider Business Mailing Address
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Address Line | 2001 70TH AVE STE 205
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City | GREELEY
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State | CO
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Zip | 80634-4613
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Country | US
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Telephone | 970-392-2190
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Fax | 970-392-2193
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | GREGORY A THWAITES
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Credential | PHD
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Telephone | 970-392-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2049
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License Number State | CO
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