Provider Demographics
NPI:1669810727
Name:GABRIEL, ESTELLE (LMT)
Entity type:Individual
Prefix:
First Name:ESTELLE
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 WAYZATA BLVD
Mailing Address - Street 2:#100
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1939
Mailing Address - Country:US
Mailing Address - Phone:952-473-9637
Mailing Address - Fax:
Practice Address - Street 1:1421 WAYZATA BLVD
Practice Address - Street 2:#100
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1939
Practice Address - Country:US
Practice Address - Phone:952-473-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53488207225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist