Provider Demographics
NPI:1801615372
Name:GONNELLA, MARGARET (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:GONNELLA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10974 PIONEER TRL
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-7970
Mailing Address - Country:US
Mailing Address - Phone:708-476-0421
Mailing Address - Fax:
Practice Address - Street 1:18210 LA GRANGE RD STE 100
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7723
Practice Address - Country:US
Practice Address - Phone:708-429-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.024518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist