Individual
KENNETH GILMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10256 S US HIGHWAY 1, PORT SAINT LUCIE, FL 34952-5615
(727) 233-7944
Mailing address
1926 SW VICTOR LN, PORT SAINT LUCIE, FL 34984-4431
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA19504
LICENSE #
FL
Enumeration date
08/30/2006
Last updated
07/08/2007
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