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NPI Code Detail

MEDICARE: GAIL LYNN MEHNERT

MEDICARE: GAIL LYNN MEHNERT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1932444353
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAIL LYNN MEHNERT
Provider Business Mailing Address
First Line : 622 MCKINLEY AVE
Second Line :
City : LAKE VILLA
State : IL
Zip : 60046-6532
Country : US
Telephone Number : 847-356-5163
Fax Number :
Provider Business Practice Location Address
First Line : 2507 N RICHMOND RD
Second Line :
City : MCHENRY
State : IL
Zip : 60051-5407
Country : US
Telephone Number : 815-363-2350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2012
Last Update Date : 12/11/2012

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Directions to “ GAIL LYNN MEHNERT ” Practice Location

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