Provider Demographics
NPI:1912409087
Name:GILMOR, NATHAN EMMANUEL (DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:EMMANUEL
Last Name:GILMOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2271
Mailing Address - Country:US
Mailing Address - Phone:406-781-2185
Mailing Address - Fax:
Practice Address - Street 1:3513 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2271
Practice Address - Country:US
Practice Address - Phone:406-781-2185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist