Provider Demographics
NPI:1588875462
Name:HAUCK, GREGORY GERALD (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:GERALD
Last Name:HAUCK
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BALLWIN ESTATES CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4992
Mailing Address - Country:US
Mailing Address - Phone:636-527-4809
Mailing Address - Fax:
Practice Address - Street 1:700 CLARK STREET
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63102-1727
Practice Address - Country:US
Practice Address - Phone:314-345-9600
Practice Address - Fax:314-345-9607
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050271532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer