Doctor Name: | SUSAN GWILLIM |
NPI Number: | 1053410159 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | |
Business Practice Address: | 5401 N Knoxville Ave Suite 218 Peoria, IL - 616145098 |
Business Phone Number: | 3096932244 |
Business Fax Number: | 3096937606 |
Mailing Address: | 5401 N Knoxville Ave, Suite 209 PEORIA |
State: | IL |
Postal Code: | 616145098 |
Phone Number: | 3096896049 |
Fax Number: | 3096896092 |
NPI Enumeration Date: | 09/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |