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NPI Code Detail

MEDICARE: MR. GABRIEL JOHN ILLES III DPT, PT

MEDICARE: MR. GABRIEL JOHN ILLES III DPT, PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation PhysicianP15135NC

General Provider Information

NPI Number : 1316449218
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GABRIEL JOHN ILLES III DPT, PT
Provider Business Mailing Address
First Line : 3701 WADE COBLE DR
Second Line :
City : BURLINGTON
State : NC
Zip : 27215-9743
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3701 WADE COBLE DR
Second Line :
City : BURLINGTON
State : NC
Zip : 27215-9743
Country : US
Telephone Number : 336-538-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2018
Last Update Date : 03/06/2018

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