Provider Demographics
NPI:1063586915
Name:GILL, MARY REBECCA (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:REBECCA
Last Name:GILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:148 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-9749
Mailing Address - Country:US
Mailing Address - Phone:302-335-1645
Mailing Address - Fax:302-335-5571
Practice Address - Street 1:65 1 CARVER ROAD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-672-1968
Practice Address - Fax:302-672-1967
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001143225100000X
PAPT007475L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist