Provider Demographics
NPI:1144388299
Name:GILMAN, MICHAEL DENNIS (PTA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DENNIS
Last Name:GILMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17910 SAN CARLOS DR
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3773
Mailing Address - Country:US
Mailing Address - Phone:707-935-3230
Mailing Address - Fax:707-935-8481
Practice Address - Street 1:17350 VAILETTI DR
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-3356
Practice Address - Country:US
Practice Address - Phone:707-935-3230
Practice Address - Fax:707-935-8481
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4619225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant