Provider Demographics
NPI:1861661878
Name:KAISER, GAIL DIANA (PT)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:DIANA
Last Name:KAISER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 S BELT LINE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7610
Mailing Address - Country:US
Mailing Address - Phone:972-745-9060
Mailing Address - Fax:972-745-9069
Practice Address - Street 1:1199 S BELT LINE RD STE 140
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-7610
Practice Address - Country:US
Practice Address - Phone:972-745-9060
Practice Address - Fax:972-745-9069
Is Sole Proprietor?:No
Enumeration Date:2008-02-23
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1091312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00171SOtherMEDICARE GROUP