Provider Demographics
NPI:1992335111
Name:FISHER, GABRIEL EDWARD (PT, DPT)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:EDWARD
Last Name:FISHER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 WEBB ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:NE
Mailing Address - Zip Code:68861-3412
Mailing Address - Country:US
Mailing Address - Phone:402-363-8932
Mailing Address - Fax:
Practice Address - Street 1:451 WEBB ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:NE
Practice Address - Zip Code:68861-3412
Practice Address - Country:US
Practice Address - Phone:402-363-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist