MEDICARE: NICOLE SUZANNE GAYLE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501013414	MI
2	225100000X	Physical Therapist	CP007623T	TN
3	225100000X	Physical Therapist	PT010018	GA

General Provider Information

NPI Number	:	1376822411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SUZANNE GAYLE PT

Provider Business Mailing Address
First Line	:	6397 LEE HWY
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:	423-238-3473
Fax Number	:

Provider Business Practice Location Address
First Line	:	11365 TARA BLVD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-6261
Country	:	US
Telephone Number	:	770-999-0849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	04/01/2024

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