Provider Demographics
NPI:1427826205
Name:MITTERER, GREGORY MAX (PT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MAX
Last Name:MITTERER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:GREG
Other - Middle Name:MAX
Other - Last Name:MITTERER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:848 W ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1758
Mailing Address - Country:US
Mailing Address - Phone:360-715-1338
Mailing Address - Fax:
Practice Address - Street 1:848 W ORCHARD DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1758
Practice Address - Country:US
Practice Address - Phone:360-715-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60664004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist