Individual
MRS. GWENDOLYNNE P GANT
Active
Individual
MRS. GWENDOLYNNE P GANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1760
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000192994
ANTHEM
KY
01
—
00907
FACILITY MEDICARE PIN
—
05
—
8700031100
—
KY
01
—
CJ8198
RAILROAD MEDICARE PIN
—
Enumeration date
02/15/2006
Last updated
08/28/2014
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