Provider Demographics
NPI:1285853218
Name:GAMBLIN, STACEY J (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:GAMBLIN
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 1:232 S TUNIS AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-5017
Mailing Address - Country:US
Mailing Address - Phone:812-682-4104
Mailing Address - Fax:
Practice Address - Street 1:251 HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:IN
Practice Address - Zip Code:47631-9075
Practice Address - Country:US
Practice Address - Phone:812-682-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist