Provider Demographics
NPI:1902375678
Name:GABAN, JANELLE L (PT)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:L
Last Name:GABAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-1677
Mailing Address - Country:US
Mailing Address - Phone:269-683-6800
Mailing Address - Fax:269-683-6888
Practice Address - Street 1:905 N FRONT ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-1677
Practice Address - Country:US
Practice Address - Phone:269-683-6800
Practice Address - Fax:269-683-6888
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist