Provider Demographics
NPI:1639724362
Name:GAMMIE, NICHOLAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GAMMIE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:GAMMIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:145 S 52ND PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6210
Mailing Address - Country:US
Mailing Address - Phone:541-988-3337
Mailing Address - Fax:
Practice Address - Street 1:145 S 52ND PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-6210
Practice Address - Country:US
Practice Address - Phone:541-988-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist