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General NPI Number Information
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NPI Number | 1437654324
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Entity Type | Individual
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Provider Name | GREGORY N OTTO PT
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Gender | Male
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 03/24/2018
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Provider Practice Location Address
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Address Line | 420 W HIGH ST
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City | DOWAGIAC
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State | MI
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Zip | 49047-1943
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Country | US
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Telephone | 269-783-3041
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Fax | 269-783-3011
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Provider Business Mailing Address
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Address Line | 15394 MEAD RD
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City | BUCHANAN
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State | MI
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Zip | 49107-9117
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Country | US
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Telephone | 269-697-4835
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501003639
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License Number State | MI
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