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NPI Code Detail

MEDICARE: MARY KATE GILDEA DPT

MEDICARE: MARY KATE GILDEA DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist003226WV

General Provider Information

NPI Number : 1316374614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATE GILDEA DPT
Provider Business Mailing Address
First Line : 1000 MAPLEWOOD DR
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-9115
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1000 MAPLEWOOD DR
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-9115
Country : US
Telephone Number : 304-842-4135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2013
Last Update Date : 10/01/2013

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Directions to “ MARY KATE GILDEA DPT” Practice Location

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