Provider Demographics
NPI:1336595560
Name:LANZENDORFER, GABRIELLE
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:LANZENDORFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 POLECAT ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:16637
Mailing Address - Country:US
Mailing Address - Phone:814-381-6373
Mailing Address - Fax:
Practice Address - Street 1:1947 POLECAT RD
Practice Address - Street 2:
Practice Address - City:EAST FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:16637-8630
Practice Address - Country:US
Practice Address - Phone:814-381-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART 0057542255A2300X
PAPT025236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer