Healthcare Provider Details

I. General information

NPI: 1699683086
Provider Name (Legal Business Name): GABRIEL GREEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 N SAINT PETERS PKWY
SAINT PETERS MO
63376-7303
US

IV. Provider business mailing address

909 MOUNTAIN BROOK CT
O FALLON MO
63366-5073
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-7500
  • Fax:
Mailing address:
  • Phone: 636-577-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026037961
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: