MEDICARE: GABRIELLE FAITH BIRT

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	070029294	IL

General Provider Information

NPI Number	:	1932096930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE FAITH BIRT

Provider Business Mailing Address
First Line	:	PO BOX 416501
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-7594
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:	631-760-8306

Provider Business Practice Location Address
First Line	:	5255 E MARYLAND ST
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-9705
Country	:	US
Telephone Number	:	217-864-1264
Fax Number	:

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

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	03/26/2026

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Directions to “ GABRIELLE FAITH BIRT ” Practice Location

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