Provider Demographics
NPI:1336389808
Name:GAENZLE, MARGARET C (MS, PT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:C
Last Name:GAENZLE
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EDWARDS MILL RD
Mailing Address - Street 2:200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5243
Mailing Address - Country:US
Mailing Address - Phone:919-781-4060
Mailing Address - Fax:919-781-5246
Practice Address - Street 1:3001 EDWARDS MILL RD
Practice Address - Street 2:200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5243
Practice Address - Country:US
Practice Address - Phone:919-781-4060
Practice Address - Fax:919-781-5246
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008409225100000X
VA2305005645225100000X
NCP13652208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5332317OtherAETNA
VAP00785164OtherRAILROAD MEDICARE
VA1336389808Medicaid
VA192960OtherBCBS (PHYSICAL THERAPY)
VA192960OtherBCBS (PHYSICAL THERAPY)
VA1336389808Medicaid