Provider Demographics
NPI:1528292182
Name:ABBOTT, GREGORY HOWARD (ATC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:HOWARD
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03887-6210
Mailing Address - Country:US
Mailing Address - Phone:603-941-0408
Mailing Address - Fax:
Practice Address - Street 1:61 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:NH
Practice Address - Zip Code:03887-6210
Practice Address - Country:US
Practice Address - Phone:603-941-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04152255A2300X
MEAT3522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer