Provider Demographics
NPI:1568604882
Name:PORSOVIGAN, GILBERT FRANCIS (OTR / L)
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:FRANCIS
Last Name:PORSOVIGAN
Suffix:
Gender:M
Credentials:OTR / L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 ASHBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5647
Mailing Address - Country:US
Mailing Address - Phone:815-254-8392
Mailing Address - Fax:
Practice Address - Street 1:7310 ASHBROOK LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5647
Practice Address - Country:US
Practice Address - Phone:815-254-8392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056003917225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056003917OtherOTR / L