Provider Demographics
NPI:1619103868
Name:GASQUE, KEVIN DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVID
Last Name:GASQUE
Suffix:
Gender:M
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:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:354 COX CREEK PKWY STE 140
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2810
Practice Address - Country:US
Practice Address - Phone:256-284-1039
Practice Address - Fax:256-284-1040
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL6082627225100000X
ALPTH5539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist