Provider Demographics
NPI:1962830810
Name:CHEEMA, GAGANDEEP
Entity Type:Individual
Prefix:
First Name:GAGANDEEP
Middle Name:
Last Name:CHEEMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 ACADIA TRL
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1016
Mailing Address - Country:US
Mailing Address - Phone:847-340-6692
Mailing Address - Fax:
Practice Address - Street 1:619 ACADIA TRL
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1016
Practice Address - Country:US
Practice Address - Phone:847-340-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist