Basic Information
| Provider Information | |||||||||
| NPI: | 1710002134 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREINER | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | TED | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. ASST. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 E NAPLES ST | ||||||||
| Address2: | RM. 28 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919112519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194826083 | ||||||||
| FaxNumber: | 6194828284 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 E NAPLES ST | ||||||||
| Address2: | RM. 28 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919112519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194826083 | ||||||||
| FaxNumber: | 6194828284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | AT4882 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.