Provider Demographics
NPI:1013005834
Name:MATTSON, GABRIEL (PT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:MATTSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 ASHLEY RIVER RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4737
Mailing Address - Country:US
Mailing Address - Phone:843-576-4121
Mailing Address - Fax:843-793-3575
Practice Address - Street 1:1964 ASHLEY RIVER RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4737
Practice Address - Country:US
Practice Address - Phone:843-576-4121
Practice Address - Fax:843-793-3575
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist