Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003264771 |
---|---|
Provider Name | Gabrielle Abrahamsen |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Tacoma, WA 98431-2212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2016 |
Last Update Date | 23/01/2020 |