Provider Demographics
NPI:1720700255
Name:WILSON, GABRIELLE INEZ (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:INEZ
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:INEZ
Other - Last Name:KLINGAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7218 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-505-7510
Mailing Address - Fax:719-505-7229
Practice Address - Street 1:7218 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-505-7510
Practice Address - Fax:719-505-7229
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016223225100000X
COMSPTL.0000010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist