Provider Demographics
NPI:1790727105
Name:QUATTLEBAUM, GAYLE (PT)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 JACKSON STEPHENS DRIVE UAMS MAILBOX #626
Mailing Address - Street 2:UNIVERSITY REHAB, GROUND FLOOR
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7199
Mailing Address - Country:US
Mailing Address - Phone:501-661-7955
Mailing Address - Fax:501-661-7961
Practice Address - Street 1:501 JACKSON STEPHENS DRIVE
Practice Address - Street 2:UAMS-UNIVERSITY REHAB, GROUND FLOOR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7199
Practice Address - Country:US
Practice Address - Phone:501-227-9920
Practice Address - Fax:501-227-5223
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y025Medicare ID - Type UnspecifiedPROVIDER NUMBER