Healthcare Provider Details

I. General information

NPI: 1255535118
Provider Name (Legal Business Name): GABRIEL JULIAN BSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SHORE DR
VIRGINIA BEACH VA
23451-1199
US

IV. Provider business mailing address

1513 STALLS WAY
VIRGINIA BEACH VA
23453-8547
US

V. Phone/Fax

Practice location:
  • Phone: 757-839-4848
  • Fax:
Mailing address:
  • Phone: 757-839-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2305006033
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: