Provider Demographics
NPI:1881692333
Name:GAGNON, MARCY S (PT)
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:S
Last Name:GAGNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:WESTENHOEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:370 HIGHLAND PARK DR
Mailing Address - Street 2:STE 1
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3546
Mailing Address - Country:US
Mailing Address - Phone:859-625-9700
Mailing Address - Fax:859-625-1555
Practice Address - Street 1:370 HIGHLAND PARK DR
Practice Address - Street 2:STE 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3546
Practice Address - Country:US
Practice Address - Phone:859-625-9700
Practice Address - Fax:859-625-1555
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1162361OtherCHA HEALTH
KY00000052194OtherBLUE CROSS
KY5020702Medicare ID - Type UnspecifiedMEDICARE