Provider Demographics
NPI:1477917664
Name:FOX, GABRIELLE BLISS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:BLISS
Last Name:FOX
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 1:455 W 4TH ST
Mailing Address - Street 2:SUITE 010
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1864
Mailing Address - Country:US
Mailing Address - Phone:419-436-8320
Mailing Address - Fax:419-436-8325
Practice Address - Street 1:455 W 4TH ST
Practice Address - Street 2:SUITE 010
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1864
Practice Address - Country:US
Practice Address - Phone:419-436-8320
Practice Address - Fax:419-436-8325
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist