Provider Demographics
NPI:1275254054
Name:VAN SCOY, GABRIELLE KENDRA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:KENDRA
Last Name:VAN SCOY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 VIRGINIA AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-4011
Mailing Address - Country:US
Mailing Address - Phone:330-998-3632
Mailing Address - Fax:
Practice Address - Street 1:374 KROGER WAY
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1915
Practice Address - Country:US
Practice Address - Phone:859-286-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY008705OtherKY STATE BOARD OF PHYSICAL THERAPY