Provider Demographics
NPI:1477591220
Name:SPENCER, GAYLA MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:GAYLA
Middle Name:MICHELE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GAYLA
Other - Middle Name:MICHELLE
Other - Last Name:BURRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:200 W DOUGLAS AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3002
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:813-524-6115
Practice Address - Street 1:9425 MISSION RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-2045
Practice Address - Country:US
Practice Address - Phone:913-381-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
36503053OtherBCBS KC
KSKA2868021OtherMEDICARE PTAN