Provider Demographics
NPI:1659891711
Name:GILL, ADRIENNE LEIGH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:LEIGH
Last Name:GILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:LEIGH
Other - Last Name:ELMQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:NE
Mailing Address - Zip Code:68883-9233
Mailing Address - Country:US
Mailing Address - Phone:712-880-1359
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 850
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68848-0850
Practice Address - Country:US
Practice Address - Phone:308-237-5927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist