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General NPI Number Information
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NPI Number | 1376822411
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Entity Type | Individual
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Provider Name | NICOLE SUZANNE GAYLE PT
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Gender | Female
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 11365 TARA BLVD
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City | HAMPTON
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State | GA
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Zip | 30228-6261
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Country | US
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Telephone | 770-999-0849
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Fax |
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Provider Business Mailing Address
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Address Line | 6397 LEE HWY
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2564
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Country | US
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Telephone | 423-238-3473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501013414
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP007623T
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT010018
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License Number State | GA
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