Provider Demographics
NPI:1770237703
Name:GAGNOR, ANTHONY V (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:V
Last Name:GAGNOR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 BIG BEAR CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3394
Mailing Address - Country:US
Mailing Address - Phone:217-891-0271
Mailing Address - Fax:
Practice Address - Street 1:101 W STATE ROUTE 92
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7590
Practice Address - Country:US
Practice Address - Phone:816-903-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300989225100000X
MO2022001775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist