Provider Demographics
NPI:1740245976
Name:GILLILAND, CHAD R (PT ATC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 WILD MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5159
Mailing Address - Country:US
Mailing Address - Phone:630-334-2686
Mailing Address - Fax:630-898-2687
Practice Address - Street 1:3206 WILD MEADOW LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5159
Practice Address - Country:US
Practice Address - Phone:630-334-2686
Practice Address - Fax:630-898-2687
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3802001OtherMEDICARE
ILIL3802001OtherMEDICARE