MEDICARE: GABRIELLE LYNN DAVENPORT

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	2251P0200X	Pediatric Physical Therapist	PT020406	OH

General Provider Information

NPI Number	:	1750244505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE LYNN DAVENPORT

Provider Business Mailing Address
First Line	:	3430 BURNET AVENUE
Second Line	:	4007
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 BURNET AVENUE
Second Line	:	4007
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2833
Country	:	US
Telephone Number	:	513-636-2858
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ GABRIELLE LYNN DAVENPORT ” Practice Location

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