MEDICARE: DR. ELIJAH MALIK GILMORE PT, DPT, CSCS

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

General Provider Information

NPI Number	:	1700741139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIJAH MALIK GILMORE PT, DPT, CSCS

Provider Business Mailing Address
First Line	:	6007 EMBASSY CT
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-8071
Country	:	US
Telephone Number	:	678-709-9210
Fax Number	:

Provider Business Practice Location Address
First Line	:	16228 STATE ROAD 54
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-3729
Country	:	US
Telephone Number	:	813-475-5599
Fax Number	:	813-565-9236

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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