Individual provider Active NPI

Cassidy Gilmore, DPT

  • Physical Therapist
  • Roanoke, VA
National Provider Identifier
1457192353
Registry record updated May 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305216442 Issued in VA
Practice address
2033 Colonial Ave SW Ste 138
Roanoke, VA 24015-3210
Phone
(540) 466-3981
Fax
(540) 739-7476
NPI assigned
Jun 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305216442 VA Primary

Addresses

Primary practice location

2033 Colonial Ave SW Ste 138
Roanoke, VA 24015-3210

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-6200

Other practice location 1

935 Fairystone Park Hwy
Stanleytown, VA 24168-3014
Phone (276) 622-3636 ext. 111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260616000895 VA Practitioner - Physical Therapist in Private Practice 5496227936 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidewater Physical Therapy LLCGroup PAC ID 6406759281, 225 clinicians

Practice addresses (Care Compare)

2033 Colonial Ave SW
Suite 138
Roanoke, VA 24015-3210
Phone (540) 466-3981

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305216442VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
O&W Enterprises Physical Therapist CurrentSince Jun 9, 2024 Accepting new patients

Locations

935 Fairystone Park Hwy
Stanleytown, VA 24168
Phone (276) 622-3636

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778803200000",
    "number": "1457192353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-6200",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 COLONIAL AVE SW STE 138",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240153210",
            "telephone_number": "540-466-3981",
            "fax_number": "540-739-7476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "935 Fairystone Park Hwy",
            "address_purpose": "LOCATION",
            "city": "Stanleytown",
            "state": "VA",
            "postal_code": "241683014",
            "country_code": "US",
            "telephone_number": "276-622-3636 x111",
            "fax_number": "276-627-0060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILMORE",
        "first_name": "CASSIDY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-04",
        "last_updated": "2026-05-15",
        "certification_date": "2026-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305216442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.