Provider Demographics
NPI:1548489917
Name:GILMORE, BENJAMIN DONALD (MPT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DONALD
Last Name:GILMORE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-8585
Mailing Address - Country:US
Mailing Address - Phone:304-834-0964
Mailing Address - Fax:
Practice Address - Street 1:215 FOY ST
Practice Address - Street 2:
Practice Address - City:POLLOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28573
Practice Address - Country:US
Practice Address - Phone:252-224-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204953225100000X
NCP12332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist