Provider Demographics
NPI:1174987366
Name:PULLIAM, GABRIELLE LYNN (DPT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:LYNN
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E LEWIS AND CLARK PKWY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1725
Mailing Address - Country:US
Mailing Address - Phone:812-283-3231
Mailing Address - Fax:812-283-3271
Practice Address - Street 1:325 E LEWIS AND CLARK PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1725
Practice Address - Country:US
Practice Address - Phone:812-283-3231
Practice Address - Fax:812-283-3271
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4773225100000X
MTPTP-PT-LIC-17045225100000X
IN05014594A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist