Provider Demographics
NPI:1053737023
Name:LEFEVER, GREGORY KENNETH (PTA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:KENNETH
Last Name:LEFEVER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15364 W PIERSON ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7736
Mailing Address - Country:US
Mailing Address - Phone:602-390-2848
Mailing Address - Fax:
Practice Address - Street 1:15364 W PIERSON ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7736
Practice Address - Country:US
Practice Address - Phone:602-390-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10511A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant