Provider Demographics
NPI:1861200404
Name:PRATA, GABRIELLA MARIE (LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:MARIE
Last Name:PRATA
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CLAPBOARD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-3634
Mailing Address - Country:US
Mailing Address - Phone:203-733-2681
Mailing Address - Fax:
Practice Address - Street 1:54 GILLOTTI RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-2597
Practice Address - Country:US
Practice Address - Phone:203-312-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer