Provider Demographics
NPI:1487963385
Name:GREGG, DYANNE (LMT)
Entity type:Individual
Prefix:
First Name:DYANNE
Middle Name:
Last Name:GREGG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-1012
Mailing Address - Country:US
Mailing Address - Phone:513-633-4483
Mailing Address - Fax:
Practice Address - Street 1:142 E JEFFERSON ST STE D
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1330
Practice Address - Country:US
Practice Address - Phone:419-358-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017934225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist