Individual provider Active NPI

Gabriel D Ettenson, PT

  • Physical Therapist
  • Niwot, CO
National Provider Identifier
1154323624
Registry record updated Jul 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
0012163 Issued in CO
Practice address
210 Franklin St
Niwot, CO 80544-5013
Phone
(516) 967-8108
Fax
(516) 967-8108
NPI assigned
Aug 13, 2005
Last updated
Jul 11, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 0012163 CO Primary

Addresses

Primary practice location

210 Franklin St
Niwot, CO 80544-5013

Mailing address

5624 Cottontail Dr
Longmont, CO 80503-9529
Phone (516) 967-8108

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
018764NYMDClinical Psychologist
018762NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
D E Delopoulos Physical Therapist CurrentSince Jun 22, 2019 Accepting new patients

Locations

261 E 78th St
Fl 2
New York, NY 10075
Phone (212) 472-5820

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783728000000",
    "number": "1154323624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5624 COTTONTAIL DR",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805039529",
            "telephone_number": "516-967-8108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 FRANKLIN ST",
            "city": "NIWOT",
            "state": "CO",
            "postal_code": "805445013",
            "telephone_number": "516-967-8108",
            "fax_number": "516-967-8108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTENSON",
        "first_name": "GABRIEL",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-13",
        "last_updated": "2026-07-11",
        "certification_date": "2026-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "0012163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niwot, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.