Basic Information
| Provider Information | |||||||||
| NPI: | 1689282956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUBBERKE | ||||||||
| FirstName: | GABRIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 461 | ||||||||
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| City: | NEVADA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502010461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153823366 | ||||||||
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| Practice Location | |||||||||
| Address1: | 109 W MCLANE ST | ||||||||
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| City: | OSCEOLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502131419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6413421470 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2020 | ||||||||
| LastUpdateDate: | 07/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 101452 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.