Provider Demographics
NPI:1447689807
Name:GILMORE, HEATHER RAE (AS)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RAE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E MARIETTA ST
Mailing Address - Street 2:
Mailing Address - City:WOODSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43793-1249
Mailing Address - Country:US
Mailing Address - Phone:740-472-2056
Mailing Address - Fax:
Practice Address - Street 1:305 E MARIETTA ST
Practice Address - Street 2:
Practice Address - City:WOODSFIELD
Practice Address - State:OH
Practice Address - Zip Code:43793-1249
Practice Address - Country:US
Practice Address - Phone:740-472-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07383225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant