Provider Demographics
NPI:1639521552
Name:KRESGE, GABRIEL (PT)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:KRESGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-8975
Mailing Address - Country:US
Mailing Address - Phone:484-515-1918
Mailing Address - Fax:
Practice Address - Street 1:3 POST OFFICE RD
Practice Address - Street 2:#105
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2756
Practice Address - Country:US
Practice Address - Phone:301-893-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist