Provider Demographics
NPI:1134345762
Name:GIL, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:GIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-1828
Mailing Address - Country:US
Mailing Address - Phone:989-771-2225
Mailing Address - Fax:989-754-2225
Practice Address - Street 1:3985 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-1828
Practice Address - Country:US
Practice Address - Phone:989-771-2225
Practice Address - Fax:989-754-2225
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI7501009996225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator