Provider Demographics
NPI:1114203338
Name:GABRIEL, ERICA MARIE (DPT)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:MARIE
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 1:10269 SW AMBROSE WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2848
Mailing Address - Country:US
Mailing Address - Phone:518-322-5140
Mailing Address - Fax:
Practice Address - Street 1:10269 SW AMBROSE WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2848
Practice Address - Country:US
Practice Address - Phone:518-322-5140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33374222Q00000X, 225100000X
NY032889225100000X
CA37459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist