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General NPI Number Information
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NPI Number | 1740924943
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Entity Type | Individual
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Provider Name | CAROLINE ANNE GACKENBACH DPT
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Gender | Female
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Dates
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Enumeration Date | 04/24/2022
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 3009 BOARDWALK CT
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City | GLENSHAW
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State | PA
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Zip | 15116-2573
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Country | US
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Telephone | 224-456-7418
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 BOARDWALK CT
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City | GLENSHAW
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State | PA
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Zip | 15116-2573
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Country | US
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Telephone | 224-456-7418
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2305214918
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT030169
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 28915
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 208692
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License Number State | AK
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