Provider Demographics
NPI:1952068066
Name:LEON, GABRIELLA NICOLE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:NICOLE
Last Name:LEON
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 1:4362 NORTHLAKE BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6269
Mailing Address - Country:US
Mailing Address - Phone:561-689-2774
Mailing Address - Fax:
Practice Address - Street 1:2917 TUSCANY CT APT 202
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2864
Practice Address - Country:US
Practice Address - Phone:516-205-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist