Provider Demographics
NPI:1134451503
Name:GILMAN, PAUL THOMAS (PTA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:THOMAS
Last Name:GILMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 WEDER RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-3605
Mailing Address - Country:US
Mailing Address - Phone:217-473-6974
Mailing Address - Fax:
Practice Address - Street 1:682 WEDER RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62694-3605
Practice Address - Country:US
Practice Address - Phone:217-473-6974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.003463225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant