Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160-002919 | IL |
NPI | 1023052693 |
---|---|
Provider Name | Kimberly Gilboe |
First Address | Morton Grove, IL 60053-2126 |
Second Address | Grayslake, IL 60030-2082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 19/03/2015 |