Provider Demographics
NPI:1801850441
Name:GILLEN, CORT DAVID (ATC)
Entity Type:Individual
Prefix:MR
First Name:CORT
Middle Name:DAVID
Last Name:GILLEN
Suffix:
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 1:12806 RAVENS CHASE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3866
Mailing Address - Country:US
Mailing Address - Phone:832-334-1312
Mailing Address - Fax:
Practice Address - Street 1:12806 RAVENS CHASE LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3866
Practice Address - Country:US
Practice Address - Phone:832-334-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer