Provider Demographics
NPI:1124067343
Name:PICKING, GREIG J (PT)
Entity type:Individual
Prefix:MR
First Name:GREIG
Middle Name:J
Last Name:PICKING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130B GROVE ST
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3668
Mailing Address - Country:US
Mailing Address - Phone:860-799-6320
Mailing Address - Fax:860-799-6621
Practice Address - Street 1:3909 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2815
Practice Address - Country:US
Practice Address - Phone:203-374-9800
Practice Address - Fax:203-374-9803
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT003517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004112140Medicaid
CT650000618Medicare ID - Type Unspecified