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General NPI Number Information
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NPI Number | 1306382775
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Entity Type | Individual
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Provider Name | DANA MICHELLE GREGORY LMT, MTI, ATSI, BS
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Gender | Female
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 3700 S W S YOUNG DR STE 110
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City | KILLEEN
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State | TX
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Zip | 76542-3416
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Country | US
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Telephone | 254-415-7587
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Fax |
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Provider Business Mailing Address
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Address Line | 5405 BARKEY CT
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City | KILLEEN
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State | TX
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Zip | 76542-4077
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Country | US
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Telephone | 254-289-6687
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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 | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number | MT108167
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT108167
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License Number State | TX
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