Provider Demographics
NPI:1164087508
Name:GAMON, KLAIRE (PT)
Entity type:Individual
Prefix:
First Name:KLAIRE
Middle Name:
Last Name:GAMON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KLAIRE
Other - Middle Name:
Other - Last Name:ADEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2662 MCFARLAND RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1419 W LANE RD STE C
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1629
Practice Address - Country:US
Practice Address - Phone:815-997-1350
Practice Address - Fax:779-207-4310
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist