Provider Demographics
NPI:1700503836
Name:GADLY, ARVA MUFADDAL (DPT)
Entity Type:Individual
Prefix:DR
First Name:ARVA
Middle Name:MUFADDAL
Last Name:GADLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ARVA
Other - Middle Name:
Other - Last Name:KHUZEMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:7191 S KINGERY HWY STE L6
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5525
Practice Address - Country:US
Practice Address - Phone:630-455-6630
Practice Address - Fax:630-455-6631
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04883801225100000X
IL070026831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist