Provider Demographics
NPI:1811262355
Name:GABANA, SHERYL (PT)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:GABANA
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 1:7100 N DAMEN AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2451
Mailing Address - Country:US
Mailing Address - Phone:773-610-8360
Mailing Address - Fax:
Practice Address - Street 1:7100 N DAMEN AVE
Practice Address - Street 2:APT. 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2451
Practice Address - Country:US
Practice Address - Phone:773-610-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015567225100000X
MO2006033085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist