Provider Demographics
NPI:1083040570
Name:MARQUEZ, GABRIELA M (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:M
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 S NEIL ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7220
Mailing Address - Country:US
Mailing Address - Phone:217-352-3330
Mailing Address - Fax:217-352-4616
Practice Address - Street 1:2040 S NEIL ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7220
Practice Address - Country:US
Practice Address - Phone:217-352-3330
Practice Address - Fax:217-352-4616
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-020256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist