Provider Demographics
NPI:1881653020
Name:GAGLIANO, YVONNE (PT)
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:
Last Name:GAGLIANO
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 1:407 E TERRA COTTA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3602
Mailing Address - Country:US
Mailing Address - Phone:847-766-0011
Mailing Address - Fax:847-999-6722
Practice Address - Street 1:407 E TERRA COTTA AVE STE E
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3602
Practice Address - Country:US
Practice Address - Phone:847-766-0011
Practice Address - Fax:847-999-6722
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ80364Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER