Provider Demographics
NPI:1447659271
Name:EUGENE, ERNEST GREGORY (MS, LAT, ATC, CES)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:GREGORY
Last Name:EUGENE
Suffix:
Gender:M
Credentials:MS, LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-5077
Mailing Address - Country:US
Mailing Address - Phone:301-537-8188
Mailing Address - Fax:
Practice Address - Street 1:605 WASHINGTON ST SW
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-1064
Practice Address - Country:US
Practice Address - Phone:540-231-4071
Practice Address - Fax:540-231-7335
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1033-392255A2300X
VA01260021422255A2300X
OHAT.0018732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer