Provider Demographics
NPI:1881638948
Name:ANDERSON, GAYLE L (RPT)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YGNACIO VALLEY RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3871
Mailing Address - Country:US
Mailing Address - Phone:925-945-6778
Mailing Address - Fax:
Practice Address - Street 1:801 YGNACIO VALLEY RD
Practice Address - Street 2:STE. 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3871
Practice Address - Country:US
Practice Address - Phone:925-945-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist