Provider Demographics
NPI:1376375055
Name:GILL, LONDON GUTHRIE
Entity type:Individual
Prefix:
First Name:LONDON
Middle Name:GUTHRIE
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42465 HIGHWAY 195
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-7052
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:256-355-0884
Practice Address - Street 1:1215 HIGHWAY 98 BYP
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3702
Practice Address - Country:US
Practice Address - Phone:601-444-5050
Practice Address - Fax:601-444-5072
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT7846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist