Individual
MARLENE GILMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2 ROOSEVELT AVE, SUITE 300, SYOSSET, NY 11791-3064
(516) 496-4460
Mailing address
PO BOX 1192, VALLEY STREAM, NY 11582-1192
(516) 528-4632
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
010049
NY
2251P0200X
Pediatric Physical Therapist
Primary
010049
NY
Other
Enumeration date
10/20/2011
Last updated
10/20/2011
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