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AUTUMN GILLIBRAND DPT

>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1407237936

Individual Registrant:
 AUTUMN  GILLIBRAND DPT
Gender: F
Not Sole Proprietor

Location and contact information for practice:
200 E CEDAR ST SUITE C LE ROY, IL 61752-1902 US
Tel: 309-962-3240  Fax: 309-962-3243

Contact information for business:
790 REMINGTON BLVD  BOLINGBROOK, IL 60440-4909 US
Tel: 630-296-2223  Fax: 630-759-9510

Registration Information:
NPI: 1407237936
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
IL070021382

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
GROUP NPI1407801012IL01




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