Provider Demographics
NPI:1457592503
Name:GANSEMER, ROBYN MARIE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ROBYN
Middle Name:MARIE
Last Name:GANSEMER
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 1:532 GREEN PARK AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:COLONA
Mailing Address - State:IL
Mailing Address - Zip Code:61241-9633
Mailing Address - Country:US
Mailing Address - Phone:309-796-3970
Mailing Address - Fax:309-796-3972
Practice Address - Street 1:532 GREEN PARK AVE APT 6
Practice Address - Street 2:
Practice Address - City:COLONA
Practice Address - State:IL
Practice Address - Zip Code:61241-9633
Practice Address - Country:US
Practice Address - Phone:309-796-3970
Practice Address - Fax:309-796-3972
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227-009577225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist