Provider Demographics
NPI:1710431846
Name:WIENKE, GABRIELLE MORGAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MORGAN
Last Name:WIENKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 VIKINGS CIR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1002
Mailing Address - Country:US
Mailing Address - Phone:952-456-7600
Mailing Address - Fax:952-456-7601
Practice Address - Street 1:2700 VIKINGS CIR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121
Practice Address - Country:US
Practice Address - Phone:952-456-7600
Practice Address - Fax:952-456-7601
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist