Provider Demographics
NPI:1467560748
Name:GAMBLE, ERNEST J (PT)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:J
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 W BAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2150
Mailing Address - Country:US
Mailing Address - Phone:609-698-1073
Mailing Address - Fax:609-698-1473
Practice Address - Street 1:890 W BAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2150
Practice Address - Country:US
Practice Address - Phone:609-698-1073
Practice Address - Fax:609-698-1473
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA010358900OtherLICENSE #