Provider Demographics
NPI:1225180474
Name:GILLES, SARA (PT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GILLES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24881 ALICIA PKWY
Mailing Address - Street 2:E 517
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4617
Mailing Address - Country:US
Mailing Address - Phone:949-916-8855
Mailing Address - Fax:
Practice Address - Street 1:24881 ALICIA PKWY
Practice Address - Street 2:E 517
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4617
Practice Address - Country:US
Practice Address - Phone:949-916-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist