Provider Demographics
NPI:1023052693
Name:GILBOE, KIMBERLY (PTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GILBOE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 WAUKEGAN RD
Mailing Address - Street 2:SUITE 200 - ATTN: RAQUEL LEON
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2126
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:
Practice Address - Street 1:1275 E BELVIDERE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2082
Practice Address - Country:US
Practice Address - Phone:847-735-0828
Practice Address - Fax:847-735-0838
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-002919225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant