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General NPI Number Information
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NPI Number | 1912104472
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Entity Type | Individual
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Provider Name | GABRIEL ENESCU PT
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Gender | Male
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 2000 W KETTLEMAN LN
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City | LODI
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State | CA
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Zip | 95242-4334
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Country | US
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Telephone | 916-716-2034
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 W KETTLEMAN LN
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City | LODI
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State | CA
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Zip | 95242-4334
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Country | US
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Telephone | 916-716-2034
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Fax | 209-370-9095
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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 | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 34617
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 34617
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 34617
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2251E1200X
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Taxonomy Name | Ergonomics Physical Therapist
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License Number | 34617
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 34617
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | 34617
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 34617
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License Number State | CA
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