Healthcare Provider Details

I. General information

NPI: 1942519574
Provider Name (Legal Business Name): CAROL GILBERT P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 BELAIR DR
LA CANADA CA
91011-3318
US

IV. Provider business mailing address

4437 BELAIR DR
LA CANADA CA
91011-3318
US

V. Phone/Fax

Practice location:
  • Phone: 818-653-6682
  • Fax: 818-952-8425
Mailing address:
  • Phone: 818-653-6682
  • Fax: 818-952-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number10344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: