Healthcare Provider Details

I. General information

NPI: 1558277756
Provider Name (Legal Business Name): GABRIELLE REYNA ROYSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GABI ROYSTON PT, DPT

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 ESKATON CIR
GRASS VALLEY CA
95945-5727
US

IV. Provider business mailing address

347 HILL ST
GRASS VALLEY CA
95945-6314
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-1778
  • Fax:
Mailing address:
  • Phone: 530-305-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: