Provider Demographics
NPI:1326009531
Name:HITCHO, THOMAS GARY (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GARY
Last Name:HITCHO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 W GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1841
Mailing Address - Country:US
Mailing Address - Phone:773-332-9853
Mailing Address - Fax:773-505-3884
Practice Address - Street 1:6526 N. WINTHROP AVE.
Practice Address - Street 2:LOYOLA UNIV. NORVILLE CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626
Practice Address - Country:US
Practice Address - Phone:773-508-2567
Practice Address - Fax:773-508-3884
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0000502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer