Provider Demographics
NPI:1740701309
Name:GEBHARDT, ABBEY ELIZABETH
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:ELIZABETH
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 FOXTRAIL DR
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1430
Mailing Address - Country:US
Mailing Address - Phone:314-603-7011
Mailing Address - Fax:
Practice Address - Street 1:3801 SELSA RD STE 7
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1712
Practice Address - Country:US
Practice Address - Phone:816-795-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170228792251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic