Healthcare Provider Details

I. General information

NPI: 1679976674
Provider Name (Legal Business Name): CORAL GUBLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 USA DR N HAHN 2050
MOBILE AL
36688-0002
US

IV. Provider business mailing address

PO BOX 40277
MOBILE AL
36640-0277
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-9378
  • Fax: 251-445-9377
Mailing address:
  • Phone: 251-445-9378
  • Fax: 251-445-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTH5225
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: