Provider Demographics
NPI:1669781431
Name:GABELSBERG, JENNIFER (MPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GABELSBERG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:300
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-370-1200
Mailing Address - Fax:310-370-1233
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:300
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-370-1200
Practice Address - Fax:310-370-1233
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT206332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT20633OtherLICENSE NUMBER