=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023816949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA ELIZABETH GILLESPIE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2025
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 NORTH DR
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48858-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-772-2957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4830 N GRANT AVE
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48625-8322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-802-1276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 5502008269
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------