Provider Demographics
NPI:1811721863
Name:GILBERT, MONTANA J (DPT)
Entity type:Individual
Prefix:
First Name:MONTANA
Middle Name:J
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 W WHITE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6498
Mailing Address - Country:US
Mailing Address - Phone:217-546-3301
Mailing Address - Fax:217-546-3302
Practice Address - Street 1:2201 W WHITE OAKS DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6498
Practice Address - Country:US
Practice Address - Phone:217-546-3301
Practice Address - Fax:217-546-3302
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.028621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist