Provider Demographics
NPI:1518952126
Name:GAMBER, WADE S (PT)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:S
Last Name:GAMBER
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 1:234 MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-1126
Mailing Address - Country:US
Mailing Address - Phone:717-871-8727
Mailing Address - Fax:717-842-2012
Practice Address - Street 1:234 MANOR AVE
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-1126
Practice Address - Country:US
Practice Address - Phone:717-871-8727
Practice Address - Fax:717-842-2012
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006783L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA576194PVAMedicare PIN