Provider Demographics
NPI:1578931796
Name:WESTLUND, GAILEY (CMT SI PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:GAILEY
Middle Name:
Last Name:WESTLUND
Suffix:
Gender:F
Credentials:CMT SI PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 W OLD SHAKOPEE RD # 3
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3000
Mailing Address - Country:US
Mailing Address - Phone:952-948-0420
Mailing Address - Fax:
Practice Address - Street 1:2120 W OLD SHAKOPEE RD # 3
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3000
Practice Address - Country:US
Practice Address - Phone:952-948-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13599174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist