Provider Demographics
NPI:1457682585
Name:GOMEZ, FRANCISCO JAVIER (PTA)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:JAVIER
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 S 58TH CT
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-1738
Mailing Address - Country:US
Mailing Address - Phone:708-949-0628
Mailing Address - Fax:
Practice Address - Street 1:1810 S 58TH CT
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-1738
Practice Address - Country:US
Practice Address - Phone:708-949-0628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005278225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant