Provider Demographics
NPI:1982896411
Name:GABOUREL, KIMBERLEE JO (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:JO
Last Name:GABOUREL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 SW 194TH TER
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5502
Mailing Address - Country:US
Mailing Address - Phone:503-642-5253
Mailing Address - Fax:
Practice Address - Street 1:6530 SW 30TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1007
Practice Address - Country:US
Practice Address - Phone:503-244-7533
Practice Address - Fax:503-244-2396
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist