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General NPI Number Information
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NPI Number | 1790133098
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Entity Type | Individual
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Provider Name | COREY PATRICK GILDEA
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Gender | Male
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 225 ALLEGHENY ST STE 3
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648
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Country | US
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Telephone | 814-931-5774
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Fax |
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Provider Business Mailing Address
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Address Line | 225 ALLEGHENY ST STE 3
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648-1849
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Country | US
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Telephone | 814-931-5774
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 25962
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT026446
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License Number State | PA
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