Provider Demographics
NPI:1679200927
Name:WILLIAMS, GABRIEL JACOB (PT, DPT)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JACOB
Last Name:WILLIAMS
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:PO BOX 775968
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80477-5968
Mailing Address - Country:US
Mailing Address - Phone:510-508-7492
Mailing Address - Fax:
Practice Address - Street 1:690 MARKETPLACE PLZ UNIT B5
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-1804
Practice Address - Country:US
Practice Address - Phone:970-819-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTLP.0000262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist