Provider Demographics
NPI:1659328896
Name:GAMBON, JULIE A (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GAMBON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20867 BRIAR BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9254
Mailing Address - Country:US
Mailing Address - Phone:309-949-2527
Mailing Address - Fax:
Practice Address - Street 1:520 VALLEY VIEW DR
Practice Address - Street 2:STE 200
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6152
Practice Address - Country:US
Practice Address - Phone:309-797-0866
Practice Address - Fax:309-797-0872
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist