Provider Demographics
NPI:1053632331
Name:GONZALES-CHUA, JOSEPHINE L (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:L
Last Name:GONZALES-CHUA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 NATIONS DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9164
Mailing Address - Country:US
Mailing Address - Phone:224-548-8114
Mailing Address - Fax:224-944-0236
Practice Address - Street 1:1790 NATIONS DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9175
Practice Address - Country:US
Practice Address - Phone:224-548-8114
Practice Address - Fax:224-494-4023
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700065322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic