Provider Demographics
NPI:1780575308
Name:MORTERA, GABRIEL PICARDO (DPT)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:PICARDO
Last Name:MORTERA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39057 DONNER WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1127
Mailing Address - Country:US
Mailing Address - Phone:510-600-5049
Mailing Address - Fax:
Practice Address - Street 1:2030 YORK RD
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1966
Practice Address - Country:US
Practice Address - Phone:708-492-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025019656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist