Healthcare Provider Details

I. General information

NPI: 1801434626
Provider Name (Legal Business Name): GABRIEL GERMAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18500 VAN HORN RD
WOODHAVEN MI
48183-3803
US

IV. Provider business mailing address

24800 BLUESTEM DR
BROWNSTOWN MI
48134-8807
US

V. Phone/Fax

Practice location:
  • Phone: 734-676-7575
  • Fax:
Mailing address:
  • Phone: 734-775-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: