Active NPI
Gingerly Bolalin, P.T.
- Physical Therapist
- Loves Park, IL
National Provider Identifier
1346538063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070018258
- Practice address
- 6131 Park Ridge Rd
Loves Park, IL 61111-4029 - Phone
- (815) 633-6810
- NPI assigned
- Jul 15, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070018258 | IL | Primary |
Addresses
Primary practice location
6131 Park Ridge Rd
Loves Park, IL 61111-4029
Mailing address
351 Bienterra TRL Apt 3
Rockford, IL 61107-5861
Phone (205) 516-5901
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070018258 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310688000000",
"number": "1346538063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "351 BIENTERRA TRL APT 3",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075861",
"telephone_number": "205-516-5901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6131 PARK RIDGE RD",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611114029",
"telephone_number": "815-633-6810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLALIN",
"first_name": "GINGERLY",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-15",
"last_updated": "2011-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070018258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loves Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.