Provider Demographics
NPI:1396845988
Name:GABRIEL, WILLIAM MARSHALL (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARSHALL
Last Name:GABRIEL
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 1:1100 RUTLAND RD APT 8
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4601
Mailing Address - Country:US
Mailing Address - Phone:323-828-1211
Mailing Address - Fax:
Practice Address - Street 1:485 E 17TH ST
Practice Address - Street 2:602
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3265
Practice Address - Country:US
Practice Address - Phone:949-722-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist