Provider Demographics
NPI:1063898765
Name:GAMBETTI, ERIN ELIZABETH (DPT, ATC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:GAMBETTI
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 VISA DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2131
Mailing Address - Country:US
Mailing Address - Phone:309-268-9000
Mailing Address - Fax:309-268-9003
Practice Address - Street 1:1603 VISA DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2131
Practice Address - Country:US
Practice Address - Phone:309-268-9000
Practice Address - Fax:309-268-9003
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL23472255A2300X
FLPT26944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer