Provider Demographics
NPI:1881043917
Name:BROADBENT, GABRIELLE ALYSSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ALYSSA
Last Name:BROADBENT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:ALYSSA
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:2946 WINFIELD DUNN PKWY
Practice Address - Street 2:STE 106
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-4306
Practice Address - Country:US
Practice Address - Phone:865-932-1088
Practice Address - Fax:865-932-1454
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist