Provider Demographics
NPI:1588257224
Name:DAEZ, GREGORIO (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:
Last Name:DAEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:GREGORIO
Other - Middle Name:TAN
Other - Last Name:DAEZ
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:728 134TH ST SW STE 203
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5322
Mailing Address - Country:US
Mailing Address - Phone:425-745-4345
Mailing Address - Fax:
Practice Address - Street 1:728 134TH ST SW STE 203
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5322
Practice Address - Country:US
Practice Address - Phone:425-745-4345
Practice Address - Fax:425-745-4835
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60173353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist