Provider Demographics
NPI:1912546789
Name:GAY, JACQUELINE JUDITH (DPT)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JUDITH
Last Name:GAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FORT PIERPONT DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1327
Mailing Address - Country:US
Mailing Address - Phone:304-241-7667
Mailing Address - Fax:304-241-7568
Practice Address - Street 1:200 FORT PIERPONT DR STE 105
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1327
Practice Address - Country:US
Practice Address - Phone:304-241-7667
Practice Address - Fax:304-241-7667
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT004039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1124806831Medicaid
WVPT004039OtherLICENSE TO PRACTICE (PT IN WV)
WV1912546789OtherINDIVIUAL NPI