Provider Demographics
NPI:1669563102
Name:STREBLOW, GREG ROBERT (PT MPS)
Entity type:Individual
Prefix:MR
First Name:GREG
Middle Name:ROBERT
Last Name:STREBLOW
Suffix:
Gender:M
Credentials:PT MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 TOMPKINS STREET
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:607-756-9886
Mailing Address - Fax:607-756-8939
Practice Address - Street 1:274 TOMPKINS STREET
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-756-9886
Practice Address - Fax:607-756-8939
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0201811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140247Medicaid
NY02140247Medicaid
NYBB7237Medicare ID - Type Unspecified