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NPI Code Detail

MEDICARE: GABRIEL JULIAN BSPT

MEDICARE: GABRIEL JULIAN BSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251G0304XGeriatric Physical Therapist2305006033VA

General Provider Information

NPI Number : 1255535118
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIEL JULIAN BSPT
Provider Business Mailing Address
First Line : 1513 STALLS WAY
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23453-8547
Country : US
Telephone Number : 757-839-4848
Fax Number :
Provider Business Practice Location Address
First Line : 3100 SHORE DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23451-1199
Country : US
Telephone Number : 757-839-4848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 07/08/2007

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Directions to “ GABRIEL JULIAN BSPT” Practice Location

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