Healthcare Provider Details

I. General information

NPI: 1013129386
Provider Name (Legal Business Name): CAROLYN ANN GILHOOLY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 STONY BROOK DR
LOUISVILLE KY
40220-4016
US

IV. Provider business mailing address

183 STRIKE HOUND CT
FISHERVILLE KY
40023-6463
US

V. Phone/Fax

Practice location:
  • Phone: 502-495-6240
  • Fax:
Mailing address:
  • Phone: 502-354-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA02364
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: