Provider Demographics
NPI:1255571378
Name:GILLON, DOROTHY MARIE (MPT)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:MARIE
Last Name:GILLON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 59TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-1019
Mailing Address - Country:US
Mailing Address - Phone:718-312-9565
Mailing Address - Fax:
Practice Address - Street 1:277 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1003
Practice Address - Country:US
Practice Address - Phone:718-312-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025584-0225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist