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NPI Code Detail

MEDICARE: DEBORAH DELAN GILLIAM PT

MEDICARE: DEBORAH DELAN GILLIAM PT
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 Therapist4882FL

General Provider Information

NPI Number : 1508244674
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH DELAN GILLIAM PT
Provider Business Mailing Address
First Line : 200 DOCTORS DR
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4559
Country : US
Telephone Number : 850-784-7724
Fax Number : 850-784-4711
Provider Business Practice Location Address
First Line : 200 DOCTORS DR
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4559
Country : US
Telephone Number : 850-784-7724
Fax Number : 850-784-4711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2015
Last Update Date : 08/04/2015

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