Provider Demographics
NPI:1598450496
Name:GILL, FABIOLA SUSANA (PTA)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:SUSANA
Last Name:GILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 ROCKLIN RD STE B
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4315
Mailing Address - Country:US
Mailing Address - Phone:916-632-2273
Mailing Address - Fax:
Practice Address - Street 1:4990 ROCKLIN RD STE B
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4315
Practice Address - Country:US
Practice Address - Phone:916-632-2273
Practice Address - Fax:916-632-2279
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51987225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant