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NPI Code Detail

MEDICARE: GREGORY PATTON GILMORE DPT

MEDICARE:   GREGORY PATTON GILMORE  DPT
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
1225100000XPhysical Therapist070020982IL

General Provider Information

NPI Number : 1720489123
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY PATTON GILMORE DPT
Provider Business Mailing Address
First Line : 333 E ONTARIO ST APT 3507B
Second Line :
City : CHICAGO
State : IL
Zip : 60611-6817
Country : US
Telephone Number : 254-709-3555
Fax Number :
Provider Business Practice Location Address
First Line : 1002 W DIVERSEY PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1317
Country : US
Telephone Number : 773-248-2578
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2014
Last Update Date : 09/04/2014

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Directions to “ GREGORY PATTON GILMORE DPT” Practice Location

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