Provider Demographics
NPI:1215280961
Name:GAMBRELL, ALEXIS M (MED, ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:M
Last Name:GAMBRELL
Suffix:
Gender:F
Credentials:MED, ATC, LAT
Other - Prefix:MS
Other - First Name:ALEXIS
Other - Middle Name:M
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, ATC, LAT
Mailing Address - Street 1:8 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-1917
Mailing Address - Country:US
Mailing Address - Phone:352-263-5413
Mailing Address - Fax:
Practice Address - Street 1:8 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-1917
Practice Address - Country:US
Practice Address - Phone:352-263-5413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021262255A2300X
FLAL30662255A2300X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer