Provider Demographics
NPI:1356552475
Name:GILLETTE, PATRICIA D (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8318 REGENCY WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3816
Mailing Address - Country:US
Mailing Address - Phone:502-499-9953
Mailing Address - Fax:502-452-8429
Practice Address - Street 1:5201 ARROWSHIRE DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9600
Practice Address - Country:US
Practice Address - Phone:502-420-0901
Practice Address - Fax:502-222-2617
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist