Healthcare Provider Details

I. General information

NPI: 1730572991
Provider Name (Legal Business Name): KARA CHANTEL GILLUM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA CHANTEL CARPENTER ATC

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 COLEMAN'S CROSSING BLVD MEMORIAL HEALTH PHYSICAL THERAPY
MARYSVILLE OH
43040
US

IV. Provider business mailing address

103 SHAWNEE DR
MARIETTA OH
45750-1249
US

V. Phone/Fax

Practice location:
  • Phone: 937-578-7841
  • Fax: 937-578-7891
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT018664
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: