Provider Demographics
NPI:1710216072
Name:GAMINDE, LILIBETH C (PT, WCC)
Entity Type:Individual
Prefix:
First Name:LILIBETH
Middle Name:C
Last Name:GAMINDE
Suffix:
Gender:F
Credentials:PT, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 CROSS AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2002
Mailing Address - Country:US
Mailing Address - Phone:812-273-4640
Mailing Address - Fax:
Practice Address - Street 1:950 CROSS AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2002
Practice Address - Country:US
Practice Address - Phone:812-273-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009220A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist