Provider Demographics
NPI:1366517070
Name:EDAUGAL, GABRIEL C (PT)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:C
Last Name:EDAUGAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9519 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-8812
Mailing Address - Country:US
Mailing Address - Phone:865-806-1935
Mailing Address - Fax:865-980-0031
Practice Address - Street 1:101 GILL ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701
Practice Address - Country:US
Practice Address - Phone:865-806-1935
Practice Address - Fax:865-980-0031
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000004252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist