Provider Demographics
NPI:1558448779
Name:GABRIEL, ROSWITHA E (PT)
Entity Type:Individual
Prefix:
First Name:ROSWITHA
Middle Name:E
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1723
Mailing Address - Country:US
Mailing Address - Phone:808-244-6878
Mailing Address - Fax:808-244-6878
Practice Address - Street 1:81 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1723
Practice Address - Country:US
Practice Address - Phone:808-244-6878
Practice Address - Fax:808-244-6878
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0225993OtherHMSA PARTICIPATING PROVID
HI557960-01Medicaid
HI557960-01Medicaid