Provider Demographics
NPI:1831402114
Name:MARTE, GILDO APA II (PT)
Entity type:Individual
Prefix:MR
First Name:GILDO
Middle Name:APA
Last Name:MARTE
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14815 W 85TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4102
Mailing Address - Country:US
Mailing Address - Phone:954-330-5400
Mailing Address - Fax:
Practice Address - Street 1:1610 THORNBURY RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-2330
Practice Address - Country:US
Practice Address - Phone:630-379-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017818172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070017818OtherPHYSICAL THERAPY LICENSE