Provider Demographics
NPI:1992149082
Name:WAY, GABRIELLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:WAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:WIERZBICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 SHEPHERD WAY
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1464
Mailing Address - Country:US
Mailing Address - Phone:732-406-5794
Mailing Address - Fax:
Practice Address - Street 1:2050 ROUTE 27 STE 107&108
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1380
Practice Address - Country:US
Practice Address - Phone:732-745-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01485200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist