Provider Demographics
NPI:1740775766
Name:GIERUT, EMILY (LMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GIERUT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 W LORIENT DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-6102
Mailing Address - Country:US
Mailing Address - Phone:815-206-9248
Mailing Address - Fax:
Practice Address - Street 1:314 W ROLLINS RD STE B
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-1204
Practice Address - Country:US
Practice Address - Phone:847-546-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.015907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist