Basic Information
| Provider Information | |||||||||
| NPI: | 1578784898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILLILAND | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | GIL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 TIMBERWALK DR | ||||||||
| Address2: | |||||||||
| City: | SIMPSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644490948 | ||||||||
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| Practice Location | |||||||||
| Address1: | 727 SE MAIN ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SIMPSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644546600 | ||||||||
| FaxNumber: | 8644546605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 363 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.