Provider Demographics
NPI:1841351087
Name:FOSTER, GEMINILDA ALLA (PT)
Entity type:Individual
Prefix:
First Name:GEMINILDA
Middle Name:ALLA
Last Name:FOSTER
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 1:725 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP HARBOR
Mailing Address - State:IL
Mailing Address - Zip Code:60096
Mailing Address - Country:US
Mailing Address - Phone:847-872-7542
Mailing Address - Fax:
Practice Address - Street 1:CONDELL MEDICAL CENTER 2 E ROLLINS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073
Practice Address - Country:US
Practice Address - Phone:847-740-2296
Practice Address - Fax:847-740-0125
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
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