Provider Demographics
NPI:1104181155
Name:GILBERT, JENNIFER L (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12104 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9702
Mailing Address - Country:US
Mailing Address - Phone:847-791-4177
Mailing Address - Fax:
Practice Address - Street 1:12104 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9702
Practice Address - Country:US
Practice Address - Phone:847-791-4177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.013215172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist