Provider Demographics
NPI:1366859480
Name:GOR, VAISHALI V (LMT)
Entity Type:Individual
Prefix:
First Name:VAISHALI
Middle Name:V
Last Name:GOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 LEE ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6420
Mailing Address - Country:US
Mailing Address - Phone:847-768-9330
Mailing Address - Fax:847-768-9336
Practice Address - Street 1:880 LEE ST
Practice Address - Street 2:SUITE 207
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6420
Practice Address - Country:US
Practice Address - Phone:847-768-9330
Practice Address - Fax:847-768-9336
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227013026225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist