Provider Demographics
NPI:1033207246
Name:GAMBILL, ROBERT THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:GAMBILL
Suffix:
Gender:M
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:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901
Mailing Address - Country:US
Mailing Address - Phone:828-321-2048
Mailing Address - Fax:828-321-5669
Practice Address - Street 1:13926 US 19
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901
Practice Address - Country:US
Practice Address - Phone:828-321-2048
Practice Address - Fax:828-321-5669
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34901OtherBLUE CROSS BLUE SHIELD
7200113OtherMEDICAID NC CROSSOVER
TN4028019OtherBCBS
NC7210175Medicaid
2504014Medicare ID - Type Unspecified