Provider Demographics
NPI:1699861849
Name:FREGOSO, THOMAS G (MS ATC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:G
Last Name:FREGOSO
Suffix:
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 BOBCAT AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-4868
Mailing Address - Country:US
Mailing Address - Phone:541-230-0826
Mailing Address - Fax:541-737-0864
Practice Address - Street 1:114 GILL COLISEUM
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8547
Practice Address - Country:US
Practice Address - Phone:541-737-4188
Practice Address - Fax:541-737-0864
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-365996174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist