Healthcare Provider Details

I. General information

NPI: 1427792308
Provider Name (Legal Business Name): GABRIELLE SPAINHOUR LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N LUNENBURG AVE
SOUTH HILL VA
23970-1520
US

IV. Provider business mailing address

708 N LUNENBURG AVE
SOUTH HILL VA
23970-1520
US

V. Phone/Fax

Practice location:
  • Phone: 434-579-0825
  • Fax:
Mailing address:
  • Phone: 434-579-0825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604725
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: