Provider Demographics
NPI:1104986231
Name:FASSBENDER, GWEN S (PT)
Entity type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:S
Last Name:FASSBENDER
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 1:2755 BENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-2559
Mailing Address - Country:US
Mailing Address - Phone:251-634-9658
Mailing Address - Fax:251-476-2882
Practice Address - Street 1:67 E MIDTOWN PARK
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4141
Practice Address - Country:US
Practice Address - Phone:251-476-1279
Practice Address - Fax:251-476-2882
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist