MEDICARE: MIRETTE GABALLA PT

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
1	225100000X	Physical Therapist	054037	NY

General Provider Information

NPI Number	:	1659238905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRETTE GABALLA PT

Provider Business Mailing Address
First Line	:	9 W SUNRISE HWY
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 W SUNRISE HWY
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520
Country	:	US
Telephone Number	:	516-585-9442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ MIRETTE GABALLA PT” Practice Location

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