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NPI Code Detail

MEDICARE: DR. EISA WILLIFORD GEMEINHARDT DPT

MEDICARE: DR. EISA WILLIFORD GEMEINHARDT DPT
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
12251P0200XPediatric Physical Therapist5906SC
2225100000XPhysical Therapist2305205596VA
3225100000XPhysical TherapistPTL.0014221CO

General Provider Information

NPI Number : 1942457064
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EISA WILLIFORD GEMEINHARDT DPT
Provider Business Mailing Address
First Line : 1234 WHITEFISH STAGE
Second Line :
City : KALISPELL
State : MT
Zip : 59901-2753
Country : US
Telephone Number : 406-756-7878
Fax Number : 406-309-2579
Provider Business Practice Location Address
First Line : 3854 VILLAGE SEVEN RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80917-2801
Country : US
Telephone Number : 719-574-8762
Fax Number : 719-574-8236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2008
Last Update Date : 12/14/2016

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