Provider Demographics
NPI:1811583958
Name:DAUBERT, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:DAUBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 MOUNTAIN VIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2096
Mailing Address - Country:US
Mailing Address - Phone:423-842-9322
Mailing Address - Fax:866-591-0619
Practice Address - Street 1:124 HARRISON LN STE 118
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4863
Practice Address - Country:US
Practice Address - Phone:423-842-9322
Practice Address - Fax:866-591-0619
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist