Healthcare Provider Details

I. General information

NPI: 1689909814
Provider Name (Legal Business Name): LAUREN MICHELLE GILLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 OVARSITY WAY SUITE 265
CINCINNATI OH
45221-0001
US

IV. Provider business mailing address

2751 OVARSITY WAY SUITE 265
CINCINNATI OH
45221-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-556-3178
  • Fax: 513-556-6506
Mailing address:
  • Phone: 513-556-3178
  • Fax: 513-556-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.012658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: