Provider Demographics
NPI:1215256474
Name:GILMORE, ROBERT ALIN (LPTA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALIN
Last Name:GILMORE
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 DORSEY EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-9030
Mailing Address - Country:US
Mailing Address - Phone:662-862-3946
Mailing Address - Fax:
Practice Address - Street 1:5838 DORSEY EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-9030
Practice Address - Country:US
Practice Address - Phone:662-862-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA2852225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant