Provider Demographics
NPI:1477039089
Name:GUSTAVSON, GAIL (DPT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:GUSTAVSON
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 1:4825 S OLD PEACHTREE RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1504
Mailing Address - Country:US
Mailing Address - Phone:770-449-5152
Mailing Address - Fax:866-821-7683
Practice Address - Street 1:4825 S OLD PEACHTREE RD STE 1100
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071-1504
Practice Address - Country:US
Practice Address - Phone:770-449-5152
Practice Address - Fax:866-821-7683
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist