Provider Demographics
NPI:1760444038
Name:GONZAGA, JOANNE CHIRISTIE CANTERO (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE CHIRISTIE
Middle Name:CANTERO
Last Name:GONZAGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JOANNE CHRISTIE
Other - Middle Name:MODINA
Other - Last Name:CANTERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7030 N SHERIDAN RD
Mailing Address - Street 2:APT. 3M
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3045
Mailing Address - Country:US
Mailing Address - Phone:773-262-0884
Mailing Address - Fax:
Practice Address - Street 1:7200 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2613
Practice Address - Country:US
Practice Address - Phone:773-973-7200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist