Individual
VICTORIA GILLENWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 765-9655
Mailing address
134 NELMS ST, SURGOINSVILLE, TN 37873-3157
(423) 444-9151
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0000005364
TN
Other
Enumeration date
06/29/2019
Last updated
06/29/2019
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