Provider Demographics
NPI:1649210626
Name:GAGLIARDI, ANTHONY J (MPT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:GAGLIARDI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:779 W SPROUL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1215
Practice Address - Country:US
Practice Address - Phone:484-470-2150
Practice Address - Fax:610-328-9283
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10002335225100000X
PAPT008422L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
93779901OtherCAREFIRST OF MD
PA000643670OtherBLUE SHIELD
PA0237454000OtherBLUE CROSS
PA650021486OtherRAILROAD MEDICARE
1649210626OtherCHAMPUS TRICARE
5070-0097OtherGHMSI
11842861OtherCAQH
DE1649210626Medicaid
0237454000OtherIBC AMERIHEALTH
PA0237454000OtherBLUE CROSS
93779901OtherCAREFIRST OF MD
PA650021486OtherRAILROAD MEDICARE