Individual
AUTUMN GILLIBRAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
200 E CEDAR ST, SUITE C, LE ROY, IL 61752-1902
(309) 962-3240
(309) 962-3243
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070021382
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407801012
GROUP NPI
IL
Enumeration date
06/10/2015
Last updated
12/12/2016
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