Provider Demographics
NPI:1144899816
Name:GAYLE-HARPER, PATRICE RANGAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:RANGAE
Last Name:GAYLE-HARPER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3553
Mailing Address - Country:US
Mailing Address - Phone:248-568-3563
Mailing Address - Fax:844-937-6841
Practice Address - Street 1:2117 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3553
Practice Address - Country:US
Practice Address - Phone:586-573-4684
Practice Address - Fax:844-937-6841
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020025225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist