Doctor Name: | MR. GREGORY STEPHAN VERGAMINI |
NPI Number: | 1043384985 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT, ATC |
License Number: | 1790-024 |
Business Practice Address: | 3500 Tower Ave Superior, WI - 548805335 |
Business Phone Number: | 7153955454 |
Business Fax Number: | |
Mailing Address: | 3500 Tower Ave, SUPERIOR |
State: | WI |
Postal Code: | 548805335 |
Phone Number: | 7153955454 |
Fax Number: | |
NPI Enumeration Date: | 11/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251S0007X |
License Number: | 1790-024 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | WI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Sports |
Taxonomy Definition: |