Provider Demographics
NPI:1710550579
Name:GILBERT, KILY CHANTEL (ATC, CSCS, LAT)
Entity Type:Individual
Prefix:
First Name:KILY
Middle Name:CHANTEL
Last Name:GILBERT
Suffix:
Gender:F
Credentials:ATC, CSCS, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 S QUINTERO WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2250
Mailing Address - Country:US
Mailing Address - Phone:541-643-5759
Mailing Address - Fax:
Practice Address - Street 1:13655 BRONCOS PKWY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-4150
Practice Address - Country:US
Practice Address - Phone:541-643-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00023352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer