MEDICARE: DR. SARAH GILLEN PT, 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
1	225100000X	Physical Therapist	1212091	TX

General Provider Information

NPI Number	:	1558639245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH GILLEN PT, DPT

Provider Business Mailing Address
First Line	:	1100 E SOUTHLAKE BLVD
Second Line	:	SUITE 250
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6357
Country	:	US
Telephone Number	:	817-488-2707
Fax Number	:	817-488-2631

Provider Business Practice Location Address
First Line	:	811 INTERNATIONAL PKWY STE 430
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4281
Country	:	US
Telephone Number	:	469-312-2585
Fax Number	:	972-776-6273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	10/03/2024

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