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NPI Code Detail

MEDICARE: RICHARD J GILL PTA

MEDICARE:   RICHARD J GILL  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 Assistant5502004016MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15502004016OTHERMISTATE OF MICHIGAN

General Provider Information

NPI Number : 1982331930
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD J GILL PTA
Provider Business Mailing Address
First Line : 2240 E HILL RD STE H
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-5425
Country : US
Telephone Number : 810-606-8766
Fax Number : 810-606-8770
Provider Business Practice Location Address
First Line : 2240 E HILL RD STE H
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-5425
Country : US
Telephone Number : 810-606-8766
Fax Number : 810-606-8770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2022
Last Update Date : 08/01/2022

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