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General NPI Number Information
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NPI Number | 1770266785
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Entity Type | Individual
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Provider Name | OLIVIA SANDERSON GREGORY DPT
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Gender | Female
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 391 SOUTHCREST CIR
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6730
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Country | US
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Telephone | 91-522-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 6325 HUMPHREYS BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-2300
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Country | US
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Telephone | 901-522-7700
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Fax | 901-522-2600
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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 | 15300
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT7612
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License Number State | MS
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