Provider Demographics
NPI:1265670756
Name:GILMORE, CARRIE LEE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LEE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:LEE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:513 W BRIDGE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-2661
Mailing Address - Country:US
Mailing Address - Phone:775-463-4500
Mailing Address - Fax:775-463-4545
Practice Address - Street 1:513 W BRIDGE ST
Practice Address - Street 2:SUITE E
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-2661
Practice Address - Country:US
Practice Address - Phone:775-463-4500
Practice Address - Fax:775-463-4545
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist