Provider Demographics
NPI:1811728058
Name:GILLESPIE, CAROLINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1525
Mailing Address - Country:US
Mailing Address - Phone:215-872-9676
Mailing Address - Fax:
Practice Address - Street 1:686 DEKALB PIKE STE 101
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1258
Practice Address - Country:US
Practice Address - Phone:610-270-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist