Provider Demographics
NPI:1992011746
Name:GILCRIS, NADINE LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:LYNN
Last Name:GILCRIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:NADINE
Other - Middle Name:LYNN
Other - Last Name:KENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH STRATFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03590-4136
Mailing Address - Country:US
Mailing Address - Phone:603-636-6223
Mailing Address - Fax:
Practice Address - Street 1:6 TERRACE ST
Practice Address - Street 2:
Practice Address - City:WHITEFIELD
Practice Address - State:NH
Practice Address - Zip Code:03598-3016
Practice Address - Country:US
Practice Address - Phone:603-837-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1006225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant