Provider Demographics
NPI:1710203740
Name:HALDEMAN, GINA ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ANN
Last Name:HALDEMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W DEPOT ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1500
Mailing Address - Country:US
Mailing Address - Phone:847-838-8085
Mailing Address - Fax:
Practice Address - Street 1:311 W DEPOT ST
Practice Address - Street 2:SUITE N
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1500
Practice Address - Country:US
Practice Address - Phone:847-838-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist