Provider Demographics
NPI:1386314185
Name:GILLESPIE PHYSICAL THERAPY
Entity type:Organization
Organization Name:GILLESPIE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-353-9791
Mailing Address - Street 1:601 21ST PL
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-3049
Mailing Address - Country:US
Mailing Address - Phone:310-922-3096
Mailing Address - Fax:310-861-8553
Practice Address - Street 1:312 S CATALINA AVE STE E
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3622
Practice Address - Country:US
Practice Address - Phone:424-353-9791
Practice Address - Fax:310-861-8553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty