Healthcare Provider Details

I. General information

NPI: 1376343061
Provider Name (Legal Business Name): GABRIELLE PEARSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E HAWTHORNE HILL LN # 70
DRAPER UT
84020-3409
US

IV. Provider business mailing address

1787 E FORT UNION BLVD
COTTONWOOD HEIGHTS UT
84121-2850
US

V. Phone/Fax

Practice location:
  • Phone: 435-879-1440
  • Fax:
Mailing address:
  • Phone: 801-883-8203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number10668612-4701
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: