Provider Demographics
NPI:1639727928
Name:DRISCOLL, GABRIELE TAWNEY (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELE
Middle Name:TAWNEY
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GABBY
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:446 COLONIAL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2390
Mailing Address - Country:US
Mailing Address - Phone:443-603-4817
Mailing Address - Fax:
Practice Address - Street 1:65 E WADSWORTH PARK DR STE 230
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8096
Practice Address - Country:US
Practice Address - Phone:385-308-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213145225100000X
MA24623261QP2000X
FLPT36754261QP2000X
MD29245261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist