Doctor Name: | JOHN GILLAM |
NPI Number: | 1225427826 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT |
License Number: | 40QA01495300 |
Business Practice Address: | 2200 Wallace Blvd Suite E Cinnaminson, NJ - 080772578 |
Business Phone Number: | 8568290015 |
Business Fax Number: | 8568290043 |
Mailing Address: | 4175 Veterans Memorial Hwy, Ste 202 RONKONKOMA |
State: | NY |
Postal Code: | 117797639 |
Phone Number: | 6315805200 |
Fax Number: | 6315805222 |
NPI Enumeration Date: | 01/20/2015 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 40QA01495300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |