Basic Information
| Provider Information | |||||||||
| NPI: | 1336893437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAMBOA | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 S HORSEPEN RD | ||||||||
| Address2: | |||||||||
| City: | HARRELLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284448867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103666109 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2350 BENTRIDGE LN APT 102 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283040591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103391731 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2022 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P21012 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.