Provider Demographics
NPI:1942423942
Name:HESS, RENATO GICANA (MS PT)
Entity Type:Individual
Prefix:
First Name:RENATO
Middle Name:GICANA
Last Name:HESS
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N CLYBOURN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6808
Mailing Address - Country:US
Mailing Address - Phone:773-472-0560
Mailing Address - Fax:773-472-0429
Practice Address - Street 1:1901 N CLYBOURN AVE STE 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6808
Practice Address - Country:US
Practice Address - Phone:773-472-0560
Practice Address - Fax:773-472-0429
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16778225100000X
IL070015911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist