Provider Demographics
NPI:1154535474
Name:GILREATH, ELIZABETH POLOVICH (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:POLOVICH
Last Name:GILREATH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:POLOVICH
Other - Last Name:GILREATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:116 HIGH PINES RDG
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6312
Mailing Address - Country:US
Mailing Address - Phone:251-928-3803
Mailing Address - Fax:
Practice Address - Street 1:110 ELECIA LN
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-8970
Practice Address - Country:US
Practice Address - Phone:251-971-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-29267OtherBCBS PROVIDER NUMBER