1164652251 NPI number — ELISA CHRISTINE GILLESPIE PT, DPT

Table of content: ELISA CHRISTINE GILLESPIE PT, DPT (NPI 1164652251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164652251 NPI number — ELISA CHRISTINE GILLESPIE PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLESPIE
Provider First Name:
ELISA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NICOLAOU
Provider Other First Name:
ELISA
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164652251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15905 BROOKWAY DRIVE
Provider Second Line Business Mailing Address:
SUITE 4210
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-794-8012
Provider Business Mailing Address Fax Number:
336-860-1642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15905 BROOKWAY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 4210
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-794-8012
Provider Business Practice Location Address Fax Number:
336-860-1642
Provider Enumeration Date:
07/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  031620 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 14293 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: P14293 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)