Healthcare Provider Details

I. General information

NPI: 1427191840
Provider Name (Legal Business Name): CAROL A GAMBELL ATC, CO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 BRIGHTON HENRIETTA TOWN LINE RD
ROCHESTER NY
14623-2813
US

IV. Provider business mailing address

2100 HYLAN DR APT. 10
ROCHESTER NY
14623-4261
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-5950
  • Fax:
Mailing address:
  • Phone: 315-427-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: