Provider Demographics
NPI:1740288935
Name:GILLIS, JOHN ANDREW (MPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:GILLIS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-6922
Mailing Address - Fax:301-656-6977
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-6922
Practice Address - Fax:301-656-6977
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD185022251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic