Individual
CHRISTINA GORMASTIC GILLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3303 FERN VALLEY RD, LOUISVILLE, KY 40213-3529
(502) 964-4889
(502) 964-9769
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5733
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
004448
KY
225100000X
Physical Therapist
Primary
004448
KY
225100000X
Physical Therapist
05008800A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000064465
ANTHEM/BCBS
KY
Enumeration date
08/01/2006
Last updated
12/02/2020
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