1912374729 NPI number — CAITLIN WINIFRED GAHART DPT, PT

Table of content: CAITLIN WINIFRED GAHART DPT, PT (NPI 1912374729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912374729 NPI number — CAITLIN WINIFRED GAHART DPT, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAHART
Provider First Name:
CAITLIN
Provider Middle Name:
WINIFRED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT, PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNULTY
Provider Other First Name:
CAITLIN
Provider Other Middle Name:
WINIFRED
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT, PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912374729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 EAST PARK AVE
Provider Second Line Business Mailing Address:
APT 2E
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-767-1484
Provider Business Mailing Address Fax Number:
847-929-1154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 SHERWOOD TERRACE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LAKE BLUFF
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-235-2392
Provider Business Practice Location Address Fax Number:
847-235-2061
Provider Enumeration Date:
08/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070021747 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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