Provider Demographics
NPI:1750574877
Name:GILLESPIE, JOSEPH EUGENE (MSPT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EUGENE
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 CHAMPION BLVD
Mailing Address - Street 2:SUITE G11-279
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2473
Mailing Address - Country:US
Mailing Address - Phone:561-912-1014
Mailing Address - Fax:561-955-1222
Practice Address - Street 1:5400 CHAMPION BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1607
Practice Address - Country:US
Practice Address - Phone:561-912-1014
Practice Address - Fax:561-955-1222
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U0308AMedicare PIN