Provider Demographics
NPI:1306962170
Name:DEAN, GREGORY A (PT)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:DEAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WYNFORD COMMONS SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3776
Mailing Address - Country:US
Mailing Address - Phone:904-377-1174
Mailing Address - Fax:
Practice Address - Street 1:2191 KENWARD CT SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4813
Practice Address - Country:US
Practice Address - Phone:904-377-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008718225100000X
GAOT004504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I650305OtherMEDICARE PROVIDER NUMBER