Provider Demographics
NPI:1225237910
Name:GILLIS, CARRIE (DPT)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:GILLIS
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 1:2176 E FRANKLIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9024
Mailing Address - Country:US
Mailing Address - Phone:208-288-1155
Mailing Address - Fax:208-288-0424
Practice Address - Street 1:866 SEVEN HILLS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4374
Practice Address - Country:US
Practice Address - Phone:702-597-8999
Practice Address - Fax:702-597-8988
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAP667ZMedicare PIN
NVV38103Medicare PIN