Provider Demographics
NPI:1942362363
Name:GAMBRILL'S PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GAMBRILL'S PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-473-4065
Mailing Address - Street 1:7817 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3556
Mailing Address - Country:US
Mailing Address - Phone:301-473-4065
Mailing Address - Fax:301-473-4085
Practice Address - Street 1:7817 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-3556
Practice Address - Country:US
Practice Address - Phone:301-473-4065
Practice Address - Fax:301-473-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD395SMedicare ID - Type UnspecifiedAWAITING GROUP #