Provider Demographics
NPI:1417722737
Name:KAGANOVSKY, GREGORY (PT, DPT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:KAGANOVSKY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 ROSEWOOD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5914
Mailing Address - Country:US
Mailing Address - Phone:805-654-8127
Mailing Address - Fax:805-654-8149
Practice Address - Street 1:450 ROSEWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5914
Practice Address - Country:US
Practice Address - Phone:805-654-8127
Practice Address - Fax:805-654-8149
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist