Provider Demographics
NPI:1770795122
Name:GOMEZ, KAREN Y (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:Y
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 N SHERIDAN RD APT 21K
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4707
Mailing Address - Country:US
Mailing Address - Phone:773-416-6443
Mailing Address - Fax:
Practice Address - Street 1:5701 N SHERIDAN RD
Practice Address - Street 2:UNIT 21K
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4707
Practice Address - Country:US
Practice Address - Phone:773-416-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-004033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46825Medicare PIN
ILK46826Medicare PIN