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NPI Code Detail

MEDICARE: DEBORAH GILLES LMT, PTA

MEDICARE: DEBORAH GILLES LMT, PTA
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
1225200000XPhysical Therapy Assistant758NE
2225700000XMassage Therapist3253NE

General Provider Information

NPI Number : 1740308352
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH GILLES LMT, PTA
Provider Business Mailing Address
First Line : 7686 WALNUT ST
Second Line :
City : OMAHA
State : NE
Zip : 68124-1717
Country : US
Telephone Number : 402-819-8477
Fax Number :
Provider Business Practice Location Address
First Line : 7686 WALNUT ST
Second Line :
City : OMAHA
State : NE
Zip : 68124-1717
Country : US
Telephone Number : 402-819-8477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 12/03/2024

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