Provider Demographics
NPI:1740625797
Name:GALIAS, JOANNA LYN TABUENA (PT, GCS)
Entity type:Individual
Prefix:MS
First Name:JOANNA LYN
Middle Name:TABUENA
Last Name:GALIAS
Suffix:
Gender:F
Credentials:PT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 W MADISON ST
Mailing Address - Street 2:APARTMENT 2905
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2515
Mailing Address - Country:US
Mailing Address - Phone:217-592-6815
Mailing Address - Fax:
Practice Address - Street 1:575 W MADISON ST
Practice Address - Street 2:APARTMENT 2905
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2515
Practice Address - Country:US
Practice Address - Phone:217-592-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0161032251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics