Provider Demographics
NPI:1851688915
Name:GILLIAM, TREVOR (DPT)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 GOODLETTE RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5488
Mailing Address - Country:US
Mailing Address - Phone:239-430-0123
Mailing Address - Fax:239-430-0124
Practice Address - Street 1:1056 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5488
Practice Address - Country:US
Practice Address - Phone:239-430-0123
Practice Address - Fax:239-430-0124
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 26598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist