Provider Demographics
NPI:1346664448
Name:WALKER, GABRIELLE STAR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:STAR
Last Name:WALKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:GABRIELLE
Other - Middle Name:STAR
Other - Last Name:CRIPPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:956 AUTUMN GLEN CT
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-0107
Mailing Address - Country:US
Mailing Address - Phone:803-240-5502
Mailing Address - Fax:
Practice Address - Street 1:252 LATITUDE LN
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8150
Practice Address - Country:US
Practice Address - Phone:803-818-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7288225100000X
NCP147062251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics