Provider Demographics
NPI:1568078962
Name:GRIFFIN, GABRIELLE ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANNE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GABBY
Other - Middle Name:ANNE
Other - Last Name:HERRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 TROY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2540
Mailing Address - Country:US
Mailing Address - Phone:618-800-4620
Mailing Address - Fax:
Practice Address - Street 1:2122 TROY RD STE 120
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2540
Practice Address - Country:US
Practice Address - Phone:612-880-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020021849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist