Provider Demographics
NPI:1790751477
Name:GAYLE, VICKI (PT DC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:GAYLE
Suffix:
Gender:F
Credentials:PT DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-277-5449
Mailing Address - Fax:607-277-5606
Practice Address - Street 1:423 FIRST ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-277-5449
Practice Address - Fax:607-277-5606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005955111N00000X
NY011170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC4730Medicare ID - Type Unspecified
U34119Medicare UPIN
NY53719BMedicare ID - Type Unspecified