Provider Demographics
NPI:1811655939
Name:FOWLER, GABRIELLA CHRISTINE (DPT)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:CHRISTINE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:780 BAGDAD RD
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3182
Mailing Address - Country:US
Mailing Address - Phone:815-450-1083
Mailing Address - Fax:
Practice Address - Street 1:187 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1233
Practice Address - Country:US
Practice Address - Phone:518-481-2440
Practice Address - Fax:518-481-2617
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY048264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist