Provider Demographics
NPI:1457623563
Name:ROBBINS, GREGORY SCOTT (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SCOTT
Last Name:ROBBINS
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 1:2222 S FRONTAGE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5271
Mailing Address - Country:US
Mailing Address - Phone:601-456-0159
Mailing Address - Fax:601-863-8505
Practice Address - Street 1:2222 S FRONTAGE RD
Practice Address - Street 2:SUITE D
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5271
Practice Address - Country:US
Practice Address - Phone:601-456-0159
Practice Address - Fax:601-863-8505
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPTAN 302G702839OtherMEDICARE