MEDICARE: TALIA R GILMOUR 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	5098	NM

General Provider Information

NPI Number	:	1710404520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIA R GILMOUR DPT

Provider Business Mailing Address
First Line	:	2506 TRAMWAY TERRACE CT NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-2317
Country	:	US
Telephone Number	:	505-280-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 COAL AVE SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-5206
Country	:	US
Telephone Number	:	505-280-6674
Fax Number	:

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

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	10/13/2020

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