MEDICARE: DR. ELISHA NELLE GULLEDGE PT

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
2	225100000X	Physical Therapist	13738	NC

General Provider Information

NPI Number	:	1922354885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISHA NELLE GULLEDGE PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:	630-759-3251

Provider Business Practice Location Address
First Line	:	2940 ROLLINGRIDGE RD
Second Line	:	SUITE 101
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-4231
Country	:	US
Telephone Number	:	630-527-0485
Fax Number	:	630-527-0917

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

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	06/03/2026

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