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General NPI Number Information
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NPI Number | 1104986231
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Entity Type | Individual
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Provider Name | GWEN S. FASSBENDER PT
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 67 E MIDTOWN PARK
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City | MOBILE
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State | AL
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Zip | 36606-4141
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Country | US
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Telephone | 251-476-1279
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Fax | 251-476-2882
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Provider Business Mailing Address
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Address Line | 2755 BENNINGTON DR
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City | MOBILE
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State | AL
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Zip | 36695-2559
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Country | US
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Telephone | 251-634-9658
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Fax | 251-476-2882
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH416
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License Number State | AL
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