Provider Demographics
NPI:1457365991
Name:GILLUND, LLOYD D (PT)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:D
Last Name:GILLUND
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21037 HOLDEN DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804
Mailing Address - Country:US
Mailing Address - Phone:563-940-7494
Mailing Address - Fax:563-359-4084
Practice Address - Street 1:21037 HOLDEN DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804
Practice Address - Country:US
Practice Address - Phone:563-359-4054
Practice Address - Fax:563-359-4084
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01892225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0474510Medicaid
IA113359Medicare ID - Type Unspecified
IA0474510Medicaid