Provider Demographics
NPI:1225048028
Name:GAIDEN, CHRISTINE BERTAUD (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:BERTAUD
Last Name:GAIDEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 WRIGHTWOOD TER
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3363
Mailing Address - Country:US
Mailing Address - Phone:847-367-3031
Mailing Address - Fax:
Practice Address - Street 1:801 S MILWAUKEE AVE
Practice Address - Street 2:STE. 283
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3204
Practice Address - Country:US
Practice Address - Phone:847-573-4390
Practice Address - Fax:847-549-6920
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist