Provider Demographics
NPI:1982786794
Name:GAMBER, VICKY J (ATC)
Entity Type:Individual
Prefix:MS
First Name:VICKY
Middle Name:J
Last Name:GAMBER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19602 HWY 57
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:TN
Mailing Address - Zip Code:38057-7170
Mailing Address - Country:US
Mailing Address - Phone:901-877-6713
Mailing Address - Fax:
Practice Address - Street 1:7601 SOUTHCREST PARKWAY
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4739
Practice Address - Country:US
Practice Address - Phone:662-349-7535
Practice Address - Fax:662-349-7540
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT03002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer