Provider Demographics
NPI:1801813647
Name:SIAO, GOLD A (PT)
Entity Type:Individual
Prefix:MR
First Name:GOLD
Middle Name:A
Last Name:SIAO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27021 RUSTIC WOOD LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2955
Mailing Address - Country:US
Mailing Address - Phone:815-995-2591
Mailing Address - Fax:
Practice Address - Street 1:350 HOUBOLT RD
Practice Address - Street 2:STE 209
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8305
Practice Address - Country:US
Practice Address - Phone:815-513-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000356528OtherGROUP ANTHEM BCBS
IN154529Medicare ID - Type UnspecifiedGROUP