Provider Demographics
NPI:1285840314
Name:GILBERT, HOLLE E (PTA)
Entity Type:Individual
Prefix:MRS
First Name:HOLLE
Middle Name:E
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17407 HILLTOP RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1037
Mailing Address - Country:US
Mailing Address - Phone:636-938-5371
Mailing Address - Fax:
Practice Address - Street 1:1935 PRAIRIE DELL RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-4328
Practice Address - Country:US
Practice Address - Phone:636-584-0556
Practice Address - Fax:636-584-7049
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116920225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant