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NPI Code Detail

MEDICARE: GREGORY CHARLES PANCAKE PT, DPT

MEDICARE: GREGORY CHARLES PANCAKE PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist14739NC
2225100000XPhysical TherapistPT014742GA

General Provider Information

NPI Number : 1235556721
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY CHARLES PANCAKE PT, DPT
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : HOOVER
State : AL
Zip : 35242-5424
Country : US
Telephone Number : 423-238-2717
Fax Number : 423-238-3473
Provider Business Practice Location Address
First Line : 4446 WASHINGTON RD STE 8
Second Line :
City : EVANS
State : GA
Zip : 30809-6361
Country : US
Telephone Number : 706-869-3352
Fax Number : 706-869-3299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2014
Last Update Date : 02/05/2021

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