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General NPI Number Information
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NPI Number | 1285179192
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Entity Type | Individual
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Provider Name | JOHN MATHEW GREGORICH JR. ATC
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Gender | Male
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Dates
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Enumeration Date | 01/01/2017
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 13838 OSPREY NEST LN APT 270
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City | ORLANDO
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State | FL
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Zip | 32837-6169
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Country | US
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Telephone | 440-669-3968
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Fax |
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Provider Business Mailing Address
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Address Line | 11118 GRANDE PINES CIR APT 213
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City | ORLANDO
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State | FL
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Zip | 32821-9310
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Country | US
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Telephone | 440-669-3968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.004350
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1811
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 002903
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT7406
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL3796
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License Number State | FL
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