Provider Demographics
NPI:1114577921
Name:GAUT, LIZABETH RAE (DPT)
Entity Type:Individual
Prefix:
First Name:LIZABETH
Middle Name:RAE
Last Name:GAUT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 S. PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-0991
Mailing Address - Country:US
Mailing Address - Phone:330-877-1500
Mailing Address - Fax:330-877-1525
Practice Address - Street 1:650 S. PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-0991
Practice Address - Country:US
Practice Address - Phone:330-877-1500
Practice Address - Fax:330-877-1525
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist