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General NPI Number Information
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NPI Number | 1467965939
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Entity Type | Individual
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Provider Name | CARLA GAIN PT
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Gender | Female
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 118 WESTHAVEN SCHOOL RD
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City | BELLEVILLE
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State | IL
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Zip | 62220-3264
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Country | US
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Telephone | 618-257-9201
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Fax | 618-257-9201
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Provider Business Mailing Address
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Address Line | 105 W A ST
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City | BELLEVILLE
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State | IL
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Zip | 62220-1326
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Country | US
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Telephone | 618-234-4294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 070-005647
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License Number State | IL
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