Provider Demographics
NPI:1003844663
Name:GAMBRELL, LORETTA G (PT)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:G
Last Name:GAMBRELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2521
Mailing Address - Country:US
Mailing Address - Phone:850-769-5371
Mailing Address - Fax:850-872-9558
Practice Address - Street 1:927 GRACE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2521
Practice Address - Country:US
Practice Address - Phone:850-769-5371
Practice Address - Fax:850-872-9558
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT73882251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics