Provider Demographics
NPI:1780413930
Name:POPE, GABRIEL JOHN (PTA)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JOHN
Last Name:POPE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1986 SW THOMAS PL
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-6421
Mailing Address - Country:US
Mailing Address - Phone:859-516-1272
Mailing Address - Fax:
Practice Address - Street 1:725 SE 202ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-6105
Practice Address - Country:US
Practice Address - Phone:503-665-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10305225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant