Provider Demographics
NPI:1174677736
Name:AGONCILLO, GIL V (PT)
Entity Type:Individual
Prefix:
First Name:GIL
Middle Name:V
Last Name:AGONCILLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9416 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1311
Mailing Address - Country:US
Mailing Address - Phone:847-673-4800
Mailing Address - Fax:847-673-9322
Practice Address - Street 1:9416 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1311
Practice Address - Country:US
Practice Address - Phone:847-673-4800
Practice Address - Fax:847-673-9322
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist