=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326651233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GISELLE DY VERMILYEA DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2020
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CHOME MISUMIMACHI
-----------------------------------------------------
City | IWAKUNI
-----------------------------------------------------
State | YAMAGUCHI
-----------------------------------------------------
Zip | 7400025
-----------------------------------------------------
Country | JP
-----------------------------------------------------
Telephone | 82-794-8332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PSC 561 BOX 147
-----------------------------------------------------
City | FPO
-----------------------------------------------------
State | AP
-----------------------------------------------------
Zip | 96310-0002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-217-1719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305213297
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------