Individual
FAITH DANETTE GABRIELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
11325 NE WEIDLER ST, PORTLAND, OR 97220-1950
(503) 251-3776
Mailing address
860 NW ANGELINE AVE, GRESHAM, OR 97030-5326
(360) 616-0924
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7364
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4111589
—
WA
Enumeration date
07/02/2007
Last updated
10/02/2008
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