Provider Demographics
NPI:1427872860
Name:GILLIAM, APRIL LEIGH
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:LEIGH
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PETALUMA BLVD N STE B10
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3051
Mailing Address - Country:US
Mailing Address - Phone:707-347-6662
Mailing Address - Fax:
Practice Address - Street 1:6 PETALUMA BLVD N STE B10
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3051
Practice Address - Country:US
Practice Address - Phone:707-347-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist