Autumn Gillibrand, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070021382 Issued in IL

Practice address

200 E Cedar St
Suite C
Le Roy, IL 61752-1902

Phone

(309) 962-3240

Fax

(309) 962-3243

NPI assigned

Jun 10, 2015

Last updated

Dec 12, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481500800000",
    "number": "1407237936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E CEDAR ST",
            "address_2": "SUITE C",
            "city": "LE ROY",
            "state": "IL",
            "postal_code": "617521902",
            "telephone_number": "309-962-3240",
            "fax_number": "309-962-3243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIBRAND",
        "first_name": "AUTUMN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-10",
        "last_updated": "2016-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070021382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1407801012",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Guy C Fincham, DDS
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• David J Hansen, D.C.
• David J James, RPH/PA
• John F. Couillard, O.D.
• Bethann Kaeb, COTA/L

• Physical Therapist in Le Roy, IL
• Providers in Le Roy, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.