Provider Demographics
NPI:1043469786
Name:GILBERT, DANA LYNN (PTA, DT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PTA, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 COUNTY ROAD 2050 E
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-2846
Mailing Address - Country:US
Mailing Address - Phone:618-925-1037
Mailing Address - Fax:618-551-2798
Practice Address - Street 1:RR 3 BOX 322
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-9517
Practice Address - Country:US
Practice Address - Phone:618-925-1037
Practice Address - Fax:618-842-2472
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160002354225200000X
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant