Provider Demographics
NPI:1972001931
Name:KILGUS, GINA (MT, CR)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:KILGUS
Suffix:
Gender:F
Credentials:MT, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 SPICEWOOD SPRINGS RD STE 402
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8500
Mailing Address - Country:US
Mailing Address - Phone:512-796-2538
Mailing Address - Fax:
Practice Address - Street 1:4412 SPICEWOOD SPRINGS RD STE 402
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8500
Practice Address - Country:US
Practice Address - Phone:512-796-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT102241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist