Provider Demographics
NPI:1043267669
Name:SPECHT, GREGORY (PT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:SPECHT
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:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-0023
Mailing Address - Country:US
Mailing Address - Phone:508-675-3200
Mailing Address - Fax:508-675-3488
Practice Address - Street 1:207 SWANSEA MALL DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4120
Practice Address - Country:US
Practice Address - Phone:508-675-3200
Practice Address - Fax:508-675-3488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASPY68701Medicare ID - Type Unspecified