Provider Demographics
NPI:1164652251
Name:GILLESPIE, ELISA CHRISTINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:CHRISTINE
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:CHRISTINE
Other - Last Name:NICOLAOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15905 BROOKWAY DRIVE
Mailing Address - Street 2:SUITE 4210
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078
Mailing Address - Country:US
Mailing Address - Phone:704-794-8012
Mailing Address - Fax:336-860-1642
Practice Address - Street 1:15905 BROOKWAY DRIVE
Practice Address - Street 2:SUITE 4210
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-794-8012
Practice Address - Fax:336-860-1642
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031620225100000X
NC14293225100000X
NCP14293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist