Provider Demographics
NPI:1063650570
Name:GILBERT, GARY REED (DPT)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:REED
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 DANTIGNAC ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2774
Mailing Address - Country:US
Mailing Address - Phone:706-823-3807
Mailing Address - Fax:706-823-3810
Practice Address - Street 1:1305 DANTIGNAC ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2774
Practice Address - Country:US
Practice Address - Phone:706-823-3807
Practice Address - Fax:706-823-3810
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I658516Medicare PIN