Provider Demographics
NPI:1942457064
Name:GEMEINHARDT, EISA WILLIFORD (DPT)
Entity Type:Individual
Prefix:DR
First Name:EISA
Middle Name:WILLIFORD
Last Name:GEMEINHARDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:1234 WHITEFISH STAGE
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2753
Mailing Address - Country:US
Mailing Address - Phone:406-756-7878
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:3854 VILLAGE SEVEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-2801
Practice Address - Country:US
Practice Address - Phone:719-574-8762
Practice Address - Fax:719-574-8236
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC59062251P0200X
VA2305205596225100000X
COPTL.0014221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics