Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1760 | KY |
NPI | 1992779854 |
---|---|
Provider Name | Mrs. Gwendolynne P Gant |
First Address | Elizabethtown, KY 42701-1834 |
Second Address | Bardstown, KY 40004-1762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 28/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000192994 | ANTHEM (01) | KY |
00907 | FACILITY MEDICARE PIN (01) | |
8700031100 | (05) | KY |
CJ8198 | RAILROAD MEDICARE PIN (01) | |
P28886 | (02) |