Individual
GREGORY GIVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MHS, SCS, ATC
Contact information
Practice address
407 E TERRA COTTA AVE STE E, CRYSTAL LAKE, IL 60014-3602
(815) 477-8004
(815) 477-8005
Mailing address
407 E TERRA COTTA AVE STE E, CRYSTAL LAKE, IL 60014-3602
(815) 477-8004
(815) 477-8005
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
070.008697
IL
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096000712
LICENSE#
IL
01
—
K46919
PTAN
IL
Enumeration date
11/01/2006
Last updated
03/11/2020
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