Provider Demographics
NPI:1689679110
Name:GAYLE, MICHAEL CHARLES (PT, MA, OCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:GAYLE
Suffix:
Gender:M
Credentials:PT, MA, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 CYPRESS CREEK RD
Mailing Address - Street 2:STE 103
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3924
Mailing Address - Country:US
Mailing Address - Phone:512-918-0044
Mailing Address - Fax:512-918-0045
Practice Address - Street 1:1103 CYPRESS CREEK RD
Practice Address - Street 2:STE 103
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3924
Practice Address - Country:US
Practice Address - Phone:512-918-0044
Practice Address - Fax:512-918-0045
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3278Medicare PIN