Provider Demographics
NPI:1083804827
Name:GABRIEL, MARY ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:GABRIEL
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 1:850 MAIN STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COALPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16627-0207
Mailing Address - Country:US
Mailing Address - Phone:814-672-5700
Mailing Address - Fax:
Practice Address - Street 1:850 MAIN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:COALPORT
Practice Address - State:PA
Practice Address - Zip Code:16627-0207
Practice Address - Country:US
Practice Address - Phone:814-672-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist