Provider Demographics
NPI:1992289896
Name:RATHZ, GABRIELLE LEIGH (PT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:LEIGH
Last Name:RATHZ
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 1:2037 RITTENHOUSE SQ APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5620
Mailing Address - Country:US
Mailing Address - Phone:267-838-2163
Mailing Address - Fax:
Practice Address - Street 1:1800 JOHN F KENNEDY BLVD STE 1800
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7434
Practice Address - Country:US
Practice Address - Phone:215-634-9713
Practice Address - Fax:215-634-9714
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027232225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT027232OtherTHE FEDERATION OF STATE BOARDS OF PHYSICAL THERAPY