Provider Demographics
NPI:1124302559
Name:GREGOIRE, DAVID BRIAN (LMT, RMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRIAN
Last Name:GREGOIRE
Suffix:
Gender:M
Credentials:LMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2532
Mailing Address - Country:US
Mailing Address - Phone:413-218-5223
Mailing Address - Fax:
Practice Address - Street 1:32 INDUSTRIAL DR E
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2387
Practice Address - Country:US
Practice Address - Phone:413-218-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9035225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist