Provider Demographics
NPI:1699716894
Name:JAMES, GREGORY SCOTT (PT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SCOTT
Last Name:JAMES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 GLENRIDGE CIR NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1133
Mailing Address - Country:US
Mailing Address - Phone:330-705-6824
Mailing Address - Fax:
Practice Address - Street 1:6310 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-3127
Practice Address - Country:US
Practice Address - Phone:330-494-6655
Practice Address - Fax:330-494-8195
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-005585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2505579Medicaid
OH4134102Medicare PIN
OH2505579Medicaid