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NPI Code Detail

MEDICARE: ROBERT WILLIAM GILSON PTA, MT

MEDICARE: ROBERT WILLIAM GILSON PTA, MT
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 Assistant27AAZ
2225200000XPhysical Therapy AssistantA1923MD

General Provider Information

NPI Number : 1881897221
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT WILLIAM GILSON PTA, MT
Provider Business Mailing Address
First Line : 11615 N 22ND ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-1701
Country : US
Telephone Number : 602-616-5488
Fax Number :
Provider Business Practice Location Address
First Line : 6246 N 19TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-1511
Country : US
Telephone Number : 602-433-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2007
Last Update Date : 07/08/2007

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Directions to “ ROBERT WILLIAM GILSON PTA, MT” Practice Location

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