MEDICARE: SUSAN HARRIS GILL 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
1	225100000X	Physical Therapist	2305003667	VA

General Provider Information

NPI Number	:	1629853700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HARRIS GILL PT

Provider Business Mailing Address
First Line	:	1164 MILLERS LN # A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-5716
Country	:	US
Telephone Number	:	757-962-3567
Fax Number	:	757-961-4824

Provider Business Practice Location Address
First Line	:	1164 MILLERS LN STE A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-5716
Country	:	US
Telephone Number	:	757-962-3567
Fax Number	:	757-961-4824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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Directions to “ SUSAN HARRIS GILL PT” Practice Location

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