Provider Demographics
NPI:1326438458
Name:WITNER, GABRIELLE (ATC)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:
Last Name:WITNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 HOOKIEKIE ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1425
Mailing Address - Country:US
Mailing Address - Phone:808-454-5664
Mailing Address - Fax:808-453-5619
Practice Address - Street 1:2100 HOOKIEKIE ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1425
Practice Address - Country:US
Practice Address - Phone:808-454-5664
Practice Address - Fax:808-453-5619
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT-1492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer