Healthcare Provider Details

I. General information

NPI: 1922354885
Provider Name (Legal Business Name): ELISHA NELLE GULLEDGE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISHA NELLE YOST PT

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2878 DALLAS VALLEY LN
APEX NC
27502-6632
US

IV. Provider business mailing address

2878 DALLAS VALLEY LN
APEX NC
27502-6632
US

V. Phone/Fax

Practice location:
  • Phone: 336-655-6508
  • Fax:
Mailing address:
  • Phone: 336-655-6508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberTGPPT602
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058573T
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058574T
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP13738
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: