Provider Demographics
NPI:1851693006
Name:SANFRATELLO, GINA GIOVANNA (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:GIOVANNA
Last Name:SANFRATELLO
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6729 W 64TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-4837
Mailing Address - Country:US
Mailing Address - Phone:773-586-4246
Mailing Address - Fax:
Practice Address - Street 1:6729 W 64TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-4837
Practice Address - Country:US
Practice Address - Phone:773-586-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-20
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005561225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL160.005561OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION