Provider Demographics
NPI:1073635777
Name:RAGHUNATH, GOPAL TERALANDUR (PT, MS, DPT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:GOPAL
Middle Name:TERALANDUR
Last Name:RAGHUNATH
Suffix:
Gender:M
Credentials:PT, MS, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E LAKE COOK RD
Mailing Address - Street 2:STE. 209
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 E LAKE COOK RD
Practice Address - Street 2:SUITE 209
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4356
Practice Address - Country:US
Practice Address - Phone:847-520-3382
Practice Address - Fax:847-520-3404
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist