Healthcare Provider Details

I. General information

NPI: 1225237910
Provider Name (Legal Business Name): CARRIE GILLIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 SEVEN HILLS DR SUITE 103
HENDERSON NV
89052-4374
US

IV. Provider business mailing address

2176 E FRANKLIN RD SUITE 100
MERIDIAN ID
83642-9024
US

V. Phone/Fax

Practice location:
  • Phone: 702-597-8999
  • Fax: 702-597-8988
Mailing address:
  • Phone: 208-288-1155
  • Fax: 208-288-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2147
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: