Provider Demographics
NPI:1215913363
Name:HEDMAN, GERD INGEBORG (PT)
Entity type:Individual
Prefix:MRS
First Name:GERD
Middle Name:INGEBORG
Last Name:HEDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ALTO PASS
Mailing Address - State:IL
Mailing Address - Zip Code:62905-1000
Mailing Address - Country:US
Mailing Address - Phone:618-893-4923
Mailing Address - Fax:
Practice Address - Street 1:6 E SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-7048
Practice Address - Country:US
Practice Address - Phone:618-684-8018
Practice Address - Fax:618-684-3328
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist