Provider Demographics
NPI:1134551468
Name:GILLIM, REX T (DPT)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:T
Last Name:GILLIM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2831 NEW HARTFORD RD
Mailing Address - Street 2:RIDGECREST MEDICAL PARK
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1320
Mailing Address - Country:US
Mailing Address - Phone:270-926-4100
Mailing Address - Fax:270-684-4678
Practice Address - Street 1:2831 NEW HARTFORD RD
Practice Address - Street 2:RIDGECREST MEDICAL PARK
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-926-4100
Practice Address - Fax:270-684-4678
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist