Healthcare Provider Details

I. General information

NPI: 1538083779
Provider Name (Legal Business Name): GABRIELLE BELLOW VINCENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 HIGHWAY 495
CLOUTIERVILLE LA
71416-2211
US

IV. Provider business mailing address

1923 HIGHWAY 495
CLOUTIERVILLE LA
71416-2211
US

V. Phone/Fax

Practice location:
  • Phone: 318-581-1685
  • Fax:
Mailing address:
  • Phone: 318-581-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA10424
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: