Provider Demographics
NPI:1326640160
Name:CONCAVAGE-NASAR, GABRIELLA (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:CONCAVAGE-NASAR
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 1:1800 SE MOBERLY LN STE 6
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7017
Mailing Address - Country:US
Mailing Address - Phone:479-715-6330
Mailing Address - Fax:479-268-5144
Practice Address - Street 1:1112 S 48TH ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5886
Practice Address - Country:US
Practice Address - Phone:479-444-6277
Practice Address - Fax:479-444-6278
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist