Provider Demographics
NPI:1033424700
Name:GAMBLE, VIRGINIA GENEVIEVE (MPT)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:GENEVIEVE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 CAMINO DEL MAR
Mailing Address - Street 2:APT 66
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014
Mailing Address - Country:US
Mailing Address - Phone:310-985-9303
Mailing Address - Fax:
Practice Address - Street 1:2825 CAMINO DEL MAR
Practice Address - Street 2:APT 66
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2038
Practice Address - Country:US
Practice Address - Phone:310-985-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT37026Medicare PIN