MEDICARE: KATHY GAMBLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2067862	TX

General Provider Information

NPI Number	:	1619394806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY GAMBLE

Provider Business Mailing Address
First Line	:	6815 MANHATTAN BLVD
Second Line	:	SUITE 204
City	:	FT WORTH
State	:	TX
Zip	:	76120-1204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6815 MANHATTAN BLVD
Second Line	:	SUITE 204
City	:	FT WORTH
State	:	TX
Zip	:	76120-1204
Country	:	US
Telephone Number	:	817-507-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	03/25/2014

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Directions to “ KATHY GAMBLE ” Practice Location

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