MEDICARE: GREGORY STEPHENS PT

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
1	225100000X	Physical Therapist	PT009267	GA

General Provider Information

NPI Number	:	1487802161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY STEPHENS PT

Provider Business Mailing Address
First Line	:	PO BOX 2829
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-2829
Country	:	US
Telephone Number	:	912-756-5699
Fax Number	:	912-756-5388

Provider Business Practice Location Address
First Line	:	804 TOWNE PARK DR
Second Line	:	SUITE 400
City	:	RINCON
State	:	GA
Zip	:	31326-5133
Country	:	US
Telephone Number	:	912-826-5450
Fax Number	:	912-826-6413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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Directions to “ GREGORY STEPHENS PT” Practice Location

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