Provider Demographics
NPI:1578092532
Name:CORDER, GABRIEL SHELTON (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:SHELTON
Last Name:CORDER
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 1:3307 TIMBERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4425
Mailing Address - Country:US
Mailing Address - Phone:410-989-3833
Mailing Address - Fax:410-946-1920
Practice Address - Street 1:710 S ANN ST FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3401
Practice Address - Country:US
Practice Address - Phone:410-989-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD26509OtherPT LICENSE