Provider Demographics
NPI:1922357219
Name:GABALDON, ADAM E (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:E
Last Name:GABALDON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 W 95TH ST
Mailing Address - Street 2:SUITE B6
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2546
Mailing Address - Country:US
Mailing Address - Phone:708-422-2960
Mailing Address - Fax:
Practice Address - Street 1:4710 W 95TH ST
Practice Address - Street 2:SUITE B6
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2546
Practice Address - Country:US
Practice Address - Phone:708-422-2960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist