Provider Demographics
NPI:1164104360
Name:HEBERT, GABRIELLE ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:ANN
Last Name:HEBERT
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 1:97053 CASTLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-5065
Mailing Address - Country:US
Mailing Address - Phone:904-624-5512
Mailing Address - Fax:
Practice Address - Street 1:6300 N WICKHAM RD STE 133B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2029
Practice Address - Country:US
Practice Address - Phone:321-421-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist