Provider Demographics
NPI:1215603675
Name:PALLANTE, GABRIEL (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:PALLANTE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 VINE ST APT 506
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1144
Mailing Address - Country:US
Mailing Address - Phone:267-690-0938
Mailing Address - Fax:
Practice Address - Street 1:175 ROUTE 70 STE 19
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2355
Practice Address - Country:US
Practice Address - Phone:609-714-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02027900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist