Provider Demographics
NPI:1356911804
Name:THOMAS, GABRIELLE ALEXANDRA (PT)
Entity type:Individual
Prefix:MISS
First Name:GABRIELLE
Middle Name:ALEXANDRA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 IVORY KEY CT # A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5463
Mailing Address - Country:US
Mailing Address - Phone:985-288-7015
Mailing Address - Fax:
Practice Address - Street 1:7004 IVORY KEY CT # A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5463
Practice Address - Country:US
Practice Address - Phone:985-288-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1345109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty