Provider Demographics
NPI:1598206369
Name:HEMGUDE, GAURI (MSCPT)
Entity Type:Individual
Prefix:
First Name:GAURI
Middle Name:
Last Name:HEMGUDE
Suffix:
Gender:F
Credentials:MSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 N ROCKVALE DR
Mailing Address - Street 2:#304
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7215 N ROCKVALE DR
Practice Address - Street 2:#304
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1085
Practice Address - Country:US
Practice Address - Phone:309-265-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist