Gregory Stuart Syvertson, PT, DPT, CFT,CCI
Individual provider Active NPI Physical Therapist · Suffolk, VA
NPI 1104800655 · NPPES record last updated Mar 18, 2026
Key facts
- NPI
- 1104800655
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2305208561 (VA)
- Practice address
- 5859 Harbour View Blvd Ste 100
Suffolk, VA 23435-3015 - Phone
- (757) 686-0205
- Fax
- (757) 686-0206
- NPI assigned
- Nov 29, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230814000247 | VA | Practitioner - Physical Therapist in Private Practice | 9830009448 |
Reassigns benefits to 1 organization Practice locations: Norfolk, VA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305208561 | VA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physiotherapy Associates, Inc. | Physical Therapist | Current | Accepting new patients |
| Masterworks Inc | Physical Therapist | Current |
Accepting new patients |
| Physiotherapy Assoicates, Inc. | Current |
Accepting new patients | |
| Physiotherapy Associates Inc | Current |
Accepting new patients | |
| Marden Rehabilitation Associates of Portage County, Inc. | Physical Therapist | Past | Accepting new patients |
Locations
20925 Professional Plz
Ste 300
Ashburn, VA 20147
Phone (703) 544-7171
6160 Kempsville Cir
Ste 303A
Norfolk, VA 23502
Phone (757) 333-3360
5859 Harbour View Blvd
Ste 100
Suffolk, VA 23435
Phone (757) 686-0205
390 John Raine Dr
Rainelle, WV 25962
Phone (304) 438-9225
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305208561 | VA | Yes |
Addresses
Primary practice location
5859 Harbour View Blvd Ste 100
Suffolk, VA 23435-3015
Mailing address
5851 Harbour View Blvd.
Suite 100
Suffolk, VA 23435
Phone (757) 686-0205
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5534228 | Other | WV | FIRST HEALTH |
| 612406500 | Other | WV | DOL FECA |
| 697891 | Other | WV | UNITED HEALTH CARE |
| 9420008-000 | Medicaid | WV | |
| 1064530 | Other | WV | BRICKSTREET WC |
| 7239017 | Other | WV | AETNA |
| 001714553 | Other | WV | MSBCBS INDIVIDUAL PIN |
| 87316 | Other | WV | UNICARE |
Other names
- Dr. Greg S Syvertson
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- William Louis Tatum Jr.
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All providers in Suffolk, VA · Physical Therapist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.