Individual
GABRIELLE KATHRYN REBECCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC/LAT
Contact information
Practice address
2201 W GAY AVE, GLADEWATER, TX 75647-4357
(903) 845-5591
Mailing address
1500 W FAIRMONT ST, APT 207, LONGVIEW, TX 75604-6300
(254) 722-1370
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT4647
TX
Other
Enumeration date
03/06/2017
Last updated
03/06/2017
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