Provider Demographics
NPI:1851561328
Name:GAVRIEL, STANLEY (DPT)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:GAVRIEL
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 1:2500 E HALLANDALE BEACH BLVD STE 611
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4839
Mailing Address - Country:US
Mailing Address - Phone:561-608-0942
Mailing Address - Fax:718-685-2101
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 611
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4839
Practice Address - Country:US
Practice Address - Phone:561-608-0942
Practice Address - Fax:561-896-2071
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0293841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300000094OtherMEDICARE (PTAN)
NY02976685Medicaid