Provider Demographics
NPI:1992070999
Name:GILMORE, LINDA SUE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:GILMORE
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 1:2400 COUNTY ROAD 240
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-5324
Mailing Address - Country:US
Mailing Address - Phone:573-826-0481
Mailing Address - Fax:573-642-9224
Practice Address - Street 1:850 WEST HOSPITAL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251
Practice Address - Country:US
Practice Address - Phone:573-642-5338
Practice Address - Fax:573-642-9224
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003029788225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist