Provider Demographics
NPI:1407463920
Name:MIKALONIS, GABRIELLE ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELIZABETH
Last Name:MIKALONIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-2615
Mailing Address - Country:US
Mailing Address - Phone:484-369-1499
Mailing Address - Fax:
Practice Address - Street 1:2401 PENNSYLVANIA AVE STE 1D5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3000
Practice Address - Country:US
Practice Address - Phone:215-236-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist