Provider Demographics
NPI:1801652896
Name:LAGUTANG, GABRIELLE KIMURA (PT, DPT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:KIMURA
Last Name:LAGUTANG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4853
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-8654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 DULCE NOMBRE DE MARIA DR
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-4909
Practice Address - Country:US
Practice Address - Phone:671-989-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ033356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist