Provider Demographics
NPI:1730572991
Name:GILLUM, KARA CHANTEL (DPT)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:CHANTEL
Last Name:GILLUM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KARA
Other - Middle Name:CHANTEL
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:103 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 COLEMAN'S CROSSING BLVD MEMORIAL HEALTH
Practice Address - Street 2:PHYSICAL THERAPY
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040
Practice Address - Country:US
Practice Address - Phone:937-578-7841
Practice Address - Fax:937-578-7891
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
OHPT0186642251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program