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NPI Code Detail

MEDICARE: MRS. MARCY S GAGNON PT

MEDICARE:  MRS. MARCY S GAGNON  PT
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
1225100000XPhysical Therapist02303KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11162361OTHERKYCHA HEALTH
200000052194OTHERKYBLUE CROSS

General Provider Information

NPI Number : 1881692333
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARCY S GAGNON PT
Provider Business Mailing Address
First Line : 370 HIGHLAND PARK DR
Second Line : STE 1
City : RICHMOND
State : KY
Zip : 40475-3546
Country : US
Telephone Number : 859-625-9700
Fax Number : 859-625-1555
Provider Business Practice Location Address
First Line : 370 HIGHLAND PARK DR
Second Line : STE 1
City : RICHMOND
State : KY
Zip : 40475-3546
Country : US
Telephone Number : 859-625-9700
Fax Number : 859-625-1555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 07/08/2007

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Directions to “ MRS. MARCY S GAGNON PT” Practice Location

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