Provider Demographics
NPI:1346339439
Name:PETERSON, GABRIEL L (PT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:L
Last Name:PETERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-3030
Mailing Address - Country:US
Mailing Address - Phone:828-631-3009
Mailing Address - Fax:828-354-0209
Practice Address - Street 1:80 SONGBIRD FOREST RD
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-0929
Practice Address - Country:US
Practice Address - Phone:828-550-3923
Practice Address - Fax:828-354-0209
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCP10300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10300OtherSTATE LICENSE