Eileen Gillstrom, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-007956 Issued in IL

Practice address

412 Nelson Rd
New Lenox, IL 60451-2946

Phone

(815) 462-1333

Fax

(815) 462-1360

NPI assigned

Jan 4, 2007

Last updated

Jun 12, 2013By 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

Other names 1

• Eileen Oneill Former name

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": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370995200000",
    "number": "1942357678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W WACKER DR",
            "address_2": "SUITE 1020",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606061216",
            "telephone_number": "312-640-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 NELSON RD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512946",
            "telephone_number": "815-462-1333",
            "fax_number": "815-462-1360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLSTROM",
        "first_name": "EILEEN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2013-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-007956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT STATE LICENSE #",
            "identifier": "070-007956",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EILEEN",
            "last_name": "ONEILL",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; 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.