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General NPI Number Information
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NPI Number | 1740006188
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Entity Type | Organization
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Legal Business Name | GREGERSEN PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 4927 N LYDELL AVE
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City | GLENDALE
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State | WI
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Zip | 53217-5849
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Country | US
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Telephone | 314-283-4459
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 W FAIRFIELD CT
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City | GLENDALE
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State | WI
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Zip | 53217-4139
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Country | US
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Telephone | 314-283-4459
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Fax |
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Authorized Official
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Title or Position | OWENER
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Name | DR. ERIK GREGERSEN
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Credential | PT
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Telephone | 314-283-4459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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