Provider Demographics
NPI:1881214351
Name:GILLESPIE PHYSICAL THERAPY & MASSAGE LLC
Entity Type:Organization
Organization Name:GILLESPIE PHYSICAL THERAPY & MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:516-385-0323
Mailing Address - Street 1:112 S OLD STATESVILLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7804
Mailing Address - Country:US
Mailing Address - Phone:704-794-8012
Mailing Address - Fax:
Practice Address - Street 1:112 S OLD STATESVILLE RD STE 102
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7804
Practice Address - Country:US
Practice Address - Phone:704-794-8012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy