Individual
TIMOTHY GAMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
94220 4TH ST, GOLD BEACH, OR 97444-7756
(541) 247-3000
Mailing address
401 CRESTVIEW DR, NAMPA, ID 83686-8896
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
09542
OR
225200000X
Physical Therapy Assistant
Primary
3291
ID
Other
Enumeration date
10/11/2017
Last updated
10/11/2017
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