Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT7388 | FL |
NPI | 1003844663 |
---|---|
Provider Name | Loretta G Gambrell |
First Address | Panama City, FL 32401-2521 |
Second Address | Panama City, FL 32401-2521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 09/07/2007 |