Provider Demographics
NPI:1699502864
Name:EBRAHIMI, GAIL DIANE
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:DIANE
Last Name:EBRAHIMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:DIANE
Other - Last Name:EBRAHIMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RRT
Mailing Address - Street 1:510 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405
Practice Address - Country:US
Practice Address - Phone:304-263-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered