Provider Demographics
NPI:1740791243
Name:GAILEY, LYDIA (DPT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:GAILEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 SIMS ST STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3873
Mailing Address - Country:US
Mailing Address - Phone:770-297-1700
Mailing Address - Fax:770-297-1702
Practice Address - Street 1:1296 SIMS ST STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3873
Practice Address - Country:US
Practice Address - Phone:770-297-1700
Practice Address - Fax:770-297-1702
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist