Provider Demographics
NPI:1053362152
Name:SCHROEDER, GREGORY PRESTON (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PRESTON
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1757
Mailing Address - Country:US
Mailing Address - Phone:801-217-3755
Mailing Address - Fax:801-217-3180
Practice Address - Street 1:1550 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1757
Practice Address - Country:US
Practice Address - Phone:801-217-3755
Practice Address - Fax:801-217-3180
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-12174225100000X
MO2005014046225100000X
UT6538047-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-012174OtherLICENSE
MO2005014046OtherPT LICENSE NO.
UT6538047-2401OtherPT LICENSE