Provider Demographics
NPI:1437658093
Name:GAMBILL, MELANIE ELLEN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ELLEN
Last Name:GAMBILL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ELLEN
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:537 E PARKCENTER BLVD APT 231
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6767
Mailing Address - Country:US
Mailing Address - Phone:208-284-3036
Mailing Address - Fax:
Practice Address - Street 1:7211 W FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0926
Practice Address - Country:US
Practice Address - Phone:208-375-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-5433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist