Individual
ALAN GIMMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 751-0066
Mailing address
6759 DAY RD, CARBONDALE, IL 62902-0497
(618) 751-0066
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005863
IL
Other
Enumeration date
06/21/2021
Last updated
06/21/2021
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