Provider Demographics
NPI:1699309815
Name:GILGANNON, CHLOE (DPT)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:GILGANNON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9716 SHADOWMERE LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-9749
Mailing Address - Country:US
Mailing Address - Phone:704-564-5519
Mailing Address - Fax:
Practice Address - Street 1:13655 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-9373
Practice Address - Country:US
Practice Address - Phone:704-246-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist