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NPI Code Detail

MEDICARE: NICOLE GILLES

MEDICARE: NICOLE GILLES
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 Therapist05010351AIN

General Provider Information

NPI Number : 1619289568
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GILLES
Provider Business Mailing Address
First Line : 4935 HILLEGAS RD STE 200
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-1943
Country : US
Telephone Number : 260-338-1241
Fax Number : 260-338-1231
Provider Business Practice Location Address
First Line : 4935 HILLEGAS RD STE 200
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-1943
Country : US
Telephone Number : 260-338-1241
Fax Number : 260-338-1231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2010
Last Update Date : 06/25/2019

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Directions to “ NICOLE GILLES ” Practice Location

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