Provider Demographics
NPI:1346069671
Name:GREGORY, CAMILLA M
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:M
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 S WEST BLVD STE A102
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7024
Mailing Address - Country:US
Mailing Address - Phone:856-690-9977
Mailing Address - Fax:
Practice Address - Street 1:1940 S WEST BLVD STE A102
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7024
Practice Address - Country:US
Practice Address - Phone:856-690-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00784900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist