Provider Demographics
NPI:1063660587
Name:GABRIEL, MELBA ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELBA
Middle Name:ANNE
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MELBA
Other - Middle Name:ANNE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1 CREEKVIEW CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4839
Mailing Address - Country:US
Mailing Address - Phone:864-286-9966
Mailing Address - Fax:864-286-9933
Practice Address - Street 1:1 CREEKVIEW CT
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4839
Practice Address - Country:US
Practice Address - Phone:864-286-9966
Practice Address - Fax:864-286-9933
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist