Provider Demographics
NPI:1679231617
Name:KING, GABRIEL (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:KING
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 1:3399 WINTON RD S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3057
Mailing Address - Country:US
Mailing Address - Phone:585-334-6000
Mailing Address - Fax:
Practice Address - Street 1:860 HARD RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8825
Practice Address - Country:US
Practice Address - Phone:585-347-1664
Practice Address - Fax:585-347-1234
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist