Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 070006532 | IL |
NPI | 1053632331 |
---|---|
Provider Name | Josephine L. Gonzales-Chua |
First Address | Gurnee, IL 60031-9164 |
Second Address | Gurnee, IL 60031-9175 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 13/09/2012 |