Provider Demographics
NPI:1306268651
Name:EBEL, GREGORY (MSAT, LAT, ATC, EMT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:EBEL
Suffix:
Gender:M
Credentials:MSAT, LAT, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W MARKET ST
Mailing Address - Street 2:CAMPBELL ATHLETICS CENTER
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1823
Mailing Address - Country:US
Mailing Address - Phone:336-272-7102
Mailing Address - Fax:336-217-7237
Practice Address - Street 1:815 W MARKET ST
Practice Address - Street 2:CAMPBELL ATHLETICS CENTER
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1823
Practice Address - Country:US
Practice Address - Phone:336-272-7102
Practice Address - Fax:336-217-7237
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP088768OtherOFFICE OF EMERGENCY MEDICAL SERVICES