Provider Demographics
NPI:1891109732
Name:GASKIN, GLORIA CRENSHAW (RPT)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:CRENSHAW
Last Name:GASKIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MYRTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-6811
Mailing Address - Country:US
Mailing Address - Phone:912-728-3370
Mailing Address - Fax:
Practice Address - Street 1:113 MYRTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:GUYTON
Practice Address - State:GA
Practice Address - Zip Code:31312-6811
Practice Address - Country:US
Practice Address - Phone:912-728-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0030682251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics