Provider Demographics
NPI:1538306535
Name:MATHUR, GAYATRI D (PT)
Entity Type:Individual
Prefix:MS
First Name:GAYATRI
Middle Name:D
Last Name:MATHUR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43 TURNBULL WOODS CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5135
Mailing Address - Country:US
Mailing Address - Phone:847-266-9328
Mailing Address - Fax:
Practice Address - Street 1:755 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2805
Practice Address - Country:US
Practice Address - Phone:847-272-7426
Practice Address - Fax:847-412-6440
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist