Provider Demographics
NPI:1033243506
Name:GAUTHIER, MARGARET T SMITH (PT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:T SMITH
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:THERESE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2440 N 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2039
Mailing Address - Country:US
Mailing Address - Phone:312-238-3114
Mailing Address - Fax:312-238-2130
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SU. 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:312-238-3114
Practice Address - Fax:312-238-3130
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology