Provider Demographics
NPI:1912489709
Name:GILYARD MEDICAL AND ONCOLOGY MASSAGE, INC.
Entity Type:Organization
Organization Name:GILYARD MEDICAL AND ONCOLOGY MASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILYARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-861-7828
Mailing Address - Street 1:7400 BLANCO RD STE 122
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4361
Mailing Address - Country:US
Mailing Address - Phone:210-861-7828
Mailing Address - Fax:
Practice Address - Street 1:7400 BLANCO RD STE 122
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4361
Practice Address - Country:US
Practice Address - Phone:210-861-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT040302163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Multi-Specialty