Provider Demographics
NPI:1841781309
Name:DUNHAM, GABRIEL
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:DUNHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 EVERGLADES CV
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5119
Mailing Address - Country:US
Mailing Address - Phone:512-721-6283
Mailing Address - Fax:
Practice Address - Street 1:15201 BURNET RD BLDG D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-3505
Practice Address - Country:US
Practice Address - Phone:737-259-6850
Practice Address - Fax:833-536-1744
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1309149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist