Provider Demographics
NPI:1053016766
Name:GREGORY, JEMIA MARIE
Entity type:Individual
Prefix:
First Name:JEMIA
Middle Name:MARIE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEMIA
Other - Middle Name:MARIE
Other - Last Name:FILIPPINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 KEMBERRY DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1355
Mailing Address - Country:US
Mailing Address - Phone:304-844-0905
Mailing Address - Fax:
Practice Address - Street 1:67 CASINO DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ANMOORE
Practice Address - State:WV
Practice Address - Zip Code:26323
Practice Address - Country:US
Practice Address - Phone:304-622-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT001393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist