Individual
KENNETH E. GILLESPIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
12126 N 79TH AVE, PEORIA, AZ 85345-8262
(623) 806-6002
Mailing address
12126 N 79TH AVE, PEORIA, AZ 85345-8262
(623) 806-6002
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
T169680
AZ
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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