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General NPI Number Information
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NPI Number | 1730572991
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Entity Type | Individual
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Provider Name | KARA CHANTEL GILLUM DPT
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Gender | Female
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 120 COLEMAN'S CROSSING BLVD MEMORIAL HEALTH PHYSICAL THERAPY
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City | MARYSVILLE
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State | OH
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Zip | 43040
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Country | US
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Telephone | 937-578-7841
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Fax | 937-578-7891
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Provider Business Mailing Address
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Address Line | 103 SHAWNEE DR
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City | MARIETTA
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State | OH
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Zip | 45750-1249
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | PT018664
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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