Provider Demographics
NPI:1891786653
Name:ALLEN-GAMBREL, ALICE K (PT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:K
Last Name:ALLEN-GAMBREL
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 1:2087 VON LIST WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2602
Mailing Address - Country:US
Mailing Address - Phone:859-421-0776
Mailing Address - Fax:
Practice Address - Street 1:2087 VON LIST WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2602
Practice Address - Country:US
Practice Address - Phone:859-421-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000320748OtherBC FOR PARIS
KY611208897-008OtherTRICARE FOR PARIS
KY87001269Medicaid
KY5026304Medicare ID - Type Unspecified