Provider Demographics
NPI:1841679263
Name:WHITNEY, GABRIEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:M
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 1:50 APPLE RD APT 23
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5386
Mailing Address - Country:US
Mailing Address - Phone:419-565-0727
Mailing Address - Fax:
Practice Address - Street 1:303 HAVERHILL ST STE 2
Practice Address - Street 2:
Practice Address - City:ROWLEY
Practice Address - State:MA
Practice Address - Zip Code:01969-2101
Practice Address - Country:US
Practice Address - Phone:978-948-5511
Practice Address - Fax:978-948-5515
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22689225100000X
TX1259168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist