Provider Demographics
NPI:1306552187
Name:GILMORE, TODD ANTHONY JR (ATC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ANTHONY
Last Name:GILMORE
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HOLMES AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5598
Mailing Address - Country:US
Mailing Address - Phone:256-541-3293
Mailing Address - Fax:
Practice Address - Street 1:9000 GREENBRIER PKWY NW
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756-4453
Practice Address - Country:US
Practice Address - Phone:256-285-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer