MEDICARE: DR. JACQUELINE JUDITH GAY DPT

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	PT004039	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PT004039	OTHER	WV	LICENSE TO PRACTICE (PT IN WV)
3	1912546789	OTHER	WV	INDIVIUAL NPI

General Provider Information

NPI Number	:	1912546789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE JUDITH GAY DPT

Provider Business Mailing Address
First Line	:	200 FORT PIERPONT DR STE 105
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-1327
Country	:	US
Telephone Number	:	304-241-7667
Fax Number	:	304-241-7568

Provider Business Practice Location Address
First Line	:	200 FORT PIERPONT DR STE 105
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-1327
Country	:	US
Telephone Number	:	304-241-7667
Fax Number	:	304-241-7667

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

Provider Enumeration Date	:	12/27/2019
Last Update Date	:	04/10/2024

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