Healthcare Provider Details

I. General information

NPI: 1740701309
Provider Name (Legal Business Name): ABBEY ELIZABETH GEBHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SELSA RD STE 7
INDEPENDENCE MO
64057-1712
US

IV. Provider business mailing address

459 FOXTRAIL DR
HAZELWOOD MO
63042-1430
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-0434
  • Fax:
Mailing address:
  • Phone: 314-603-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2017022879
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: