Provider Demographics
NPI:1033242086
Name:UGASTE, BRIDGET (DPT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:UGASTE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:SHAUGHNESSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1001 MEADOWCREST RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1535
Mailing Address - Country:US
Mailing Address - Phone:630-202-6190
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist